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General NPI Number Information
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NPI Number | 1164493250
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Entity Type | Individual
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Provider Name | ROBERT CORNELIUS LUTEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/28/2006
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 655 W 8TH ST UFJP EMERGENCY MEDICINE
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 904-244-7234
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Fax | 904-244-4508
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Provider Business Mailing Address
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Address Line | PO BOX 44008 UFJP PROVIDER ENROLLMENT
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City | JACKSONVILLE
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State | FL
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Zip | 32231-4008
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME34114
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | ME34114
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME34114
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License Number State | FL
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