MEDICARE: JAMIE BRIANNE LUETKEMEYER M.D.

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
1	207Q00000X	Family Medicine Physician	2012016139	MO

General Provider Information

NPI Number	:	1386906899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE BRIANNE LUETKEMEYER M.D.

Provider Business Mailing Address
First Line	:	1014 MADISON ST
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-3458
Country	:	US
Telephone Number	:	573-644-6999
Fax Number	:	573-644-7880

Provider Business Practice Location Address
First Line	:	1014 MADISON ST
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-3458
Country	:	US
Telephone Number	:	573-644-6999
Fax Number	:	573-644-7880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	02/11/2016

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