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Individual

MARY ELAINE LUTHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
619 N PROVIDENCE RD, COLUMBIA, MO 65203-4355
(573) 234-1070
Mailing address
1901 N PARKSIDE CT, COLUMBIA, MO 65202-7879
(214) 422-7605

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2024034282
MO
390200000X
Student in an Organized Health Care Education/Training Program
2024034282
MO

Other

Enumeration date
10/15/2024
Last updated
10/15/2024
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