Provider Demographics
NPI:1316913346
Name:LUETHCKE, DAVID ROSS (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROSS
Last Name:LUETHCKE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:701 S FRY RD
Mailing Address - Street 2:#200
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2255
Mailing Address - Country:US
Mailing Address - Phone:281-829-0000
Mailing Address - Fax:281-829-6303
Practice Address - Street 1:701 S FRY RD
Practice Address - Street 2:#200
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2255
Practice Address - Country:US
Practice Address - Phone:281-829-0000
Practice Address - Fax:281-829-6303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TXH0579208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24511Medicare UPIN