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General NPI Number Information
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NPI Number | 1699758532
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Entity Type | Individual
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Provider Name | JOHN LAWRENCE LUETKEMEYER M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 1717 N E ST STE 425
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City | PENSACOLA
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State | FL
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Zip | 32501-6333
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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 | PO BOX 17567
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City | PENSACOLA
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State | FL
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Zip | 32522-7567
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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 |
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 0055746
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License Number State | FL
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