Provider Demographics
NPI:1144465915
Name:LUTTER, PAUL MICHAEL (DMSC, PA-C)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:LUTTER
Suffix:
Gender:M
Credentials:DMSC, PA-C
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Other - Middle Name:
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Mailing Address - Street 1:2419 W SOUTHLAKE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:H100 SANTA MARGARITA ROAD
Practice Address - Street 2:NAVAL HOSPITAL, CAMP PENDLETON ATTN: CODE 094
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5191
Practice Address - Country:US
Practice Address - Phone:760-725-7029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20011363A00000X
TXPA11499363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant