Active NPI
Johnathan Mark Luth, DO
- General Practice Physician
- Jacksonville, FL
National Provider Identifier
1548903040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 0102208035
- Practice address
- 964 Ajax Street
Jacksonville, FL 32212 - Phone
- (904) 546-7094
- NPI assigned
- Apr 14, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 0102208035 | VA | Primary |
Addresses
Primary practice location
964 Ajax Street
Jacksonville, FL 32212
Mailing address
8901 Wisconsin Ave
Bethesda, MD 20889-0004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102208035 | VA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649894400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710201600000",
"number": "1548903040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8901 WISCONSIN AVE",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208890004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "964 AJAX STREET",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "32212",
"telephone_number": "904-546-7094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTH",
"first_name": "JOHNATHAN",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-04-14",
"last_updated": "2024-03-12",
"certification_date": "2024-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "VA",
"license": "0102208035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.