Individual
ELIZABETH ANN LUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5307
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5374
(601) 984-5714
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
22220
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02335571
—
MS
05
—
145320
—
AL
01
—
P01277046
RAILROAD MEDICARE PTAN
MS
Enumeration date
06/18/2008
Last updated
04/08/2014
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