Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | R8935 | TX |
N | 207QS0010X | Family Doctor - Sports Medicine | R8935 | TX |
NPI | 1033645296 |
---|---|
Provider Name | Ryan Daniel Lurtsema |
First Address | Lubbock, TX 79430-0002 |
Second Address | Lubbock, TX 79430-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2017 |
Last Update Date | 02/12/2021 |