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Individual
JACOB RICHARD LAUTZE
Active
Individual
JACOB RICHARD LAUTZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
210678
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
25MA12631500
NJ
Other
Enumeration date
04/05/2022
Last updated
08/30/2026
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