Basic Information
| Provider Information | |||||||||
| NPI: | 1700815891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUTZ | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | OTTO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7987 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366700987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | 2516337367 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 SPRING HILL AVE | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366073326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514333344 | ||||||||
| FaxNumber: | 2514334052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 24282 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 24282 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 212074 | 05 | AL | MEDICAID | 09286019 | 01 | MS | MS MEDICAID | OTHER | 212047 | 05 | AL | MEDICAID | 221309 | 05 | AL | MEDICAID | H92906 | 01 | AL | VIVA HEALTH | OTHER | P00319341 | 01 | AL | RR MEDICARE | OTHER | 051535063 | 01 | AL | MEDICARE | OTHER | 7758434 | 01 | AL | AETNA | OTHER | 512-07157 | 01 | AL | BCBS | OTHER | 515-35061 | 01 | AL | BCBS | OTHER | 2626772 | 01 | AL | UHC | OTHER | 512-07156 | 01 | AL | BCBS | OTHER | 9937486 | 05 | AL | MEDICAID | 220477 | 05 | AL | MEDICAID | 588428 | 01 | AL | CIGNA HC | OTHER |