Provider Demographics
NPI:1861419632
Name:LUY, ANNIE T (MD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:T
Last Name:LUY
Suffix:
Gender:F
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 1424
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-1424
Mailing Address - Country:US
Mailing Address - Phone:501-279-1472
Mailing Address - Fax:501-268-4385
Practice Address - Street 1:1407 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4659
Practice Address - Country:US
Practice Address - Phone:501-279-1472
Practice Address - Fax:501-268-4385
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE0465208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG14221Medicare UPIN
AR5J873Medicare ID - Type Unspecified