Provider Demographics
NPI:1285210773
Name:LUTHER, JACOB PADRAIG REILLEY (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:PADRAIG REILLEY
Last Name:LUTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 HOSPITAL PKWY STE 700
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1102
Mailing Address - Country:US
Mailing Address - Phone:408-972-3807
Mailing Address - Fax:
Practice Address - Street 1:21481 N. RAND RD.
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:KILDEER
Practice Address - State:IL
Practice Address - Zip Code:60047-3061
Practice Address - Country:US
Practice Address - Phone:331-221-9544
Practice Address - Fax:847-618-0676
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA184683207QS0010X
390200000X
IL036170914207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program