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General NPI Number Information
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NPI Number | 1245694983
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Entity Type | Individual
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Provider Name | LUTHER CHARLES PA, MD
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Gender | Male
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 14820 N CAVE CREEK RD STE 2
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City | PHOENIX
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State | AZ
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Zip | 85032-4951
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Country | US
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Telephone | 833-242-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 E THUNDERBIRD RD
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City | PHOENIX
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State | AZ
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Zip | 85022-5600
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Country | US
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Telephone | 561-502-6388
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | TPPA266
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9229
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License Number State | AZ
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