Healthcare Provider Details

I. General information

NPI: 1205893179
Provider Name (Legal Business Name): RAYMOND LUNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E SPRING VALLEY PIKE
CENTERVILLE OH
45458-2653
US

IV. Provider business mailing address

220 SPRING VALLEY ROAD
CENTERVILLE OH
45458-2653
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-3117
  • Fax: 937-436-0730
Mailing address:
  • Phone: 937-436-3117
  • Fax: 937-436-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35073231L
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35073231
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: