Organization
REX EDWARD LUTTRELL MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REX E LUTTRELL MD (OWNER)
(501) 978-4343
Entity
Organization
Contact information
Practice address
1300 BRADEN ST, POD B, JACKSONVILLE, AR 72076-3719
(501) 978-4343
(501) 975-8995
Mailing address
PO BOX 5209, JACKSONVILLE, AR 72078-5209
(501) 978-4343
(501) 975-8995
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MC2274
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149546002
—
AR
Enumeration date
08/01/2006
Last updated
08/25/2009
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