# DR. JAY ALLEN LUGTHART

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1215059241
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | JL039848 | MI | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | JL039848 | MI | — |
| 208D00000X | General Practice Physician | JL039848 | MI | Yes |

## Other

- **Enumeration date:** 04/03/2007
- **Last updated:** 04/01/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0107011492 | BCBS | — |
| 01 | — | 114151PC | CCPPO, CHMO, MERCY HEALTH | — |
| 01 | — | 121787 | HEALR | — |
| 01 | — | 152756 | PHCS | — |
| 01 | — | 4099325 | AETNA | — |
| 01 | — | B44069 | PRIORITY HEALTH | MI |