Healthcare Provider Details

I. General information

NPI: 1578502456
Provider Name (Legal Business Name): THOMAS R LUTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HARRIS PKWY
FORT WORTH TX
76132-4124
US

IV. Provider business mailing address

PO BOX 8549
FORT WORTH TX
76124-0549
US

V. Phone/Fax

Practice location:
  • Phone: 817-570-8500
  • Fax:
Mailing address:
  • Phone: 817-451-4208
  • Fax: 817-563-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM0157
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: