MEDICARE: DR. DAVID JAMES LUTHER 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	207QA0505X	Adult Medicine Physician	M5435	ID

General Provider Information

NPI Number	:	1699723411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JAMES LUTHER M.D.

Provider Business Mailing Address
First Line	:	229 S. 7TH STREET
Second Line	:
City	:	SAINT MARIES
State	:	ID
Zip	:	83861
Country	:	US
Telephone Number	:	208-245-5551
Fax Number	:	208-245-4921

Provider Business Practice Location Address
First Line	:	229 S. 7TH STREET
Second Line	:
City	:	SAINT MARIES
State	:	ID
Zip	:	83861
Country	:	US
Telephone Number	:	208-245-5551
Fax Number	:	208-245-4921

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	11/22/2016

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