Healthcare Provider Details

I. General information

NPI: 1063498061
Provider Name (Legal Business Name): BRIAN WILLIAM LUFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 FOREST AVE STE 202
ZANESVILLE OH
43701-2875
US

IV. Provider business mailing address

860 BETHESDA DR
ZANESVILLE OH
43701-1800
US

V. Phone/Fax

Practice location:
  • Phone: 740-450-1687
  • Fax: 740-450-1693
Mailing address:
  • Phone: 740-454-4651
  • Fax: 740-454-4653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35077127L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: