NPIMap

Organization Active NPI

Rex Edward Luttrell MD PA

  • Surgery Physician
  • Jacksonville, AR
National Provider Identifier
1548276223
Registry record updated Aug 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MC2274 Issued in AR
Legal business name
REX EDWARD LUTTRELL MD PA
Practice address
1300 Braden St
Pod B
Jacksonville, AR 72076-3719
Phone
(501) 978-4343
Fax
(501) 975-8995
NPI assigned
Aug 1, 2006
Last updated
Aug 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rex E Luttrell, MDNPI 1477559680
Title
Owner
Phone
(501) 978-4343

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X MC2274 AR Primary

Addresses

Primary practice location

1300 Braden St
Pod B
Jacksonville, AR 72076-3719

Mailing address

PO Box 5209
Jacksonville, AR 72078-5209
Phone (501) 978-4343

Other identifiers 1

IdentifierTypeStateIssuer
149546002MedicaidAR

National Provider Directory

National Provider Directory

Locations

1300 Braden St
#B
Jacksonville, AR 72076
Phone (501) 978-4343

5 Saint Vincent Cir
Ste 410
Little Rock, AR 72205
Phone (501) 978-4343

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251158400000",
    "number": "1548276223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5209",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720785209",
            "telephone_number": "501-978-4343",
            "fax_number": "501-975-8995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 BRADEN ST",
            "address_2": "POD B",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720763719",
            "telephone_number": "501-978-4343",
            "fax_number": "501-975-8995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REX EDWARD LUTTRELL MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2009-08-25",
        "status": "A",
        "authorized_official_last_name": "LUTTRELL",
        "authorized_official_first_name": "REX",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-978-4343",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "AR",
            "license": "MC2274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149546002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.