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General NPI Number Information
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NPI Number | 1306952106
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Entity Type | Individual
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Provider Name | STEVAN W LUTHER MD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 830 BALL ST
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City | SEDRO WOOLLEY
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State | WA
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Zip | 98284-0450
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Country | US
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Telephone | 360-855-1411
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Fax | 360-855-1933
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Provider Business Mailing Address
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Address Line | PO BOX 450
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City | SEDRO WOOLLEY
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State | WA
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Zip | 98284-0450
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Country | US
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Telephone | 360-855-1411
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Fax | 360-855-1933
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00013149
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License Number State | WA
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