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NPI Code Detail

MEDICARE: MARY ELAINE LUTHER MD

MEDICARE: MARY ELAINE LUTHER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramAR

General Provider Information

NPI Number : 1154141117
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELAINE LUTHER MD
Provider Business Mailing Address
First Line : 42 W FORSYTHIA DR APT 6
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4455
Country : US
Telephone Number : 214-422-7605
Fax Number :
Provider Business Practice Location Address
First Line : 1125 N COLLEGE AVE
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-1908
Country : US
Telephone Number : 479-521-0263
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2024
Last Update Date : 05/19/2026

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Directions to “ MARY ELAINE LUTHER MD” Practice Location

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