Provider Demographics
NPI:1730262486
Name:PRINCE, LUTHER TERRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:LUTHER
Middle Name:TERRENCE
Last Name:PRINCE
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE VETERAN'S DRIVE
Mailing Address - Street 2:VETERAN AFFAIRS MEDICAL CENTER
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417
Mailing Address - Country:US
Mailing Address - Phone:612-467-5987
Mailing Address - Fax:612-725-2142
Practice Address - Street 1:ONE VETERAN'S DRIVE
Practice Address - Street 2:VETERAN AFFAIRS MEDICAL CENTER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417
Practice Address - Country:US
Practice Address - Phone:612-467-5987
Practice Address - Fax:612-725-2142
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN37672208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation