Basic Information
Provider Information | |||||||||
NPI: | 1851384143 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LUTHER | ||||||||
FirstName: | GORDON | ||||||||
MiddleName: | ELLIOT | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HANNIGAN-LUTHER | ||||||||
OtherFirstName: | GORDON | ||||||||
OtherMiddleName: | ELLIOT | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1593 E POLSTON AVE | ||||||||
Address2: |   | ||||||||
City: | POST FALLS | ||||||||
State: | ID | ||||||||
PostalCode: | 838545326 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2082622300 | ||||||||
FaxNumber: | 2082622390 | ||||||||
Practice Location | |||||||||
Address1: | 750 N SYRINGA ST STE 100 | ||||||||
Address2: |   | ||||||||
City: | POST FALLS | ||||||||
State: | ID | ||||||||
PostalCode: | 838545275 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2082622600 | ||||||||
FaxNumber: | 2082622700 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/23/2005 | ||||||||
LastUpdateDate: | 08/04/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/04/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | M7856 | ID | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | M-7856 | ID | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.