Healthcare Provider Details

I. General information

NPI: 1093760142
Provider Name (Legal Business Name): JAMES T LUTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES T LUTZ MD

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S PATTERSON BLVD STE 120
DAYTON OH
45402-2643
US

IV. Provider business mailing address

1222 S PATTERSON BLVD STE 120
DAYTON OH
45402-2643
US

V. Phone/Fax

Practice location:
  • Phone: 937-701-0099
  • Fax: 833-428-4745
Mailing address:
  • Phone: 937-701-0099
  • Fax: 833-428-4745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35057139
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: