Provider Demographics
NPI:1699758532
Name:LUETKEMEYER, JOHN LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:LUETKEMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17567
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7567
Mailing Address - Country:US
Mailing Address - Phone:850-433-6580
Mailing Address - Fax:
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:STE 425
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6333
Practice Address - Country:US
Practice Address - Phone:850-433-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0055746207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC47413Medicare UPIN
FL09095Medicare ID - Type Unspecified