Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 114747 | NY |
NPI | 1104825306 |
---|---|
Provider Name | Thomas Lutz |
First Address | Olean, NY 14760-1513 |
Second Address | Olean, NY 14760-1513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01406899 | (05) | NY |
B29635 | (02) | NY |