Healthcare Provider Details
I. General information
NPI: 1578595096
Provider Name (Legal Business Name): THOMAS LANGWORTHY LUZIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 07/07/2006
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
201 S LLOYD ST STE W110
ABERDEEN SD
57401-4512
US
IV. Provider business mailing address
201 S LLOYD ST STE W110
ABERDEEN SD
57401-4512
US
V. Phone/Fax
- Phone: 605-225-0025
- Fax: 605-225-2259
- Phone: 605-225-0025
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207K00000X |
| Taxonomy | Allergy & Immunology Physician |
| License Number | SD1359 |
| License Number State | SD |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: