Provider Demographics
NPI:1356395693
Name:LENTZ, JOHN LUTHER JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LUTHER
Last Name:LENTZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:LUKE
Other - Last Name:LENTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:737 HIGHWAY 98 E STE 1
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2538
Mailing Address - Country:US
Mailing Address - Phone:850-424-6841
Mailing Address - Fax:850-424-6845
Practice Address - Street 1:737 HIGHWAY 98 E STE 1
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2538
Practice Address - Country:US
Practice Address - Phone:850-424-6841
Practice Address - Fax:850-424-6845
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD99264Medicare UPIN