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General NPI Number Information
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NPI Number | 1609273515
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Entity Type | Organization
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Legal Business Name | JOHN L. LUETKEMEYER, M.D.
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 9400 UNIVERSITY PKWY SUITE 401
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City | PENSACOLA
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State | FL
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Zip | 32514-5485
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Country | US
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Telephone | 850-433-6580
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Fax |
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Provider Business Mailing Address
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Address Line | 9400 UNIVERSITY PKWY SUITE 401
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City | PENSACOLA
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State | FL
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Zip | 32514-5485
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Country | US
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Telephone | 850-433-6580
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARJE LUETKEMEYER
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Credential | RN, BSN
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Telephone | 850-433-6580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | ME 55746
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License Number State | FL
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