Healthcare Provider Details

I. General information

NPI: 1194765552
Provider Name (Legal Business Name): DOUGLAS S WON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 N MACARTHUR BLVD SUITE 101
IRVING TX
75038-6497
US

IV. Provider business mailing address

PO BOX 202737
DALLAS TX
75320-2737
US

V. Phone/Fax

Practice location:
  • Phone: 972-255-5588
  • Fax: 972-255-6688
Mailing address:
  • Phone: 972-255-5588
  • Fax: 972-255-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberL9018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: