Individual
MR. JOSEPH LUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
200 MAPLEWOOD AVE, RONCEVERTE, WV 24970-1334
(304) 647-1148
(304) 793-2208
Mailing address
200 MAPLEWOOD AVE, RONCEVERTE, WV 24970-1334
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
536
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48/47
MTST BCBS
WV
01
—
970003810
CIGNA
WV
Enumeration date
07/17/2006
Last updated
03/12/2009
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