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Individual

DR. JOHN RUSSELL LUELLEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1000 DUTCH RIDGE RD, BEAVER, PA 15009-9727
(724) 773-3418
(724) 773-4648
Mailing address
9011 PEREGRINE DR, GIBSONIA, PA 15044-8061
(412) 913-5634

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD065589L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0017116600001
PA
05
0017116600011
PA
05
2229190
OH
Enumeration date
06/30/2005
Last updated
04/29/2008
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