Individual
MR. THOMAS MARK LUTRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4701 MANNING DR, COLLEYVILLE, TX 76034-4220
(214) 227-2457
Mailing address
PO BOX 1255, COLLEYVILLE, TX 76034-1255
(214) 227-2457
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA03123
TX
Other
Enumeration date
06/04/2006
Last updated
10/22/2013
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