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NPI Code Detail

MEDICARE: REX E LUTTRELL M.D.

MEDICARE: REX E LUTTRELL 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
1208600000XSurgery PhysicianC-6721AR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P01071366OTHERRRMEDICARE
5P00004959OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
216173000000OTHERARQUALCHOICE
317-20039OTHERARUNITED HEALTHCARE

General Provider Information

NPI Number : 1477559680
Entity Type Code : Individual
Provider Name (Legal Business Name) : REX E LUTTRELL M.D.
Provider Business Mailing Address
First Line : PO BOX 5209
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72078-5209
Country : US
Telephone Number : 501-978-4343
Fax Number : 501-975-8995
Provider Business Practice Location Address
First Line : 1300 BRADEN ST
Second Line : POD B
City : JACKSONVILLE
State : AR
Zip : 72076-3719
Country : US
Telephone Number : 501-978-4343
Fax Number : 501-975-8995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 10/25/2012

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Directions to “ REX E LUTTRELL M.D.” Practice Location

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