Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 47481 | CO |
NPI | 1023233707 |
---|---|
Provider Name | Dr. Joseph Randall Lutt |
First Address | Longmont, CO 80501-9617 |
Second Address | Boulder, CO 80301-1880 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 05/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43779875 | (05) | CO |