Healthcare Provider Details

I. General information

NPI: 1437376555
Provider Name (Legal Business Name): DOUGLAS S. WON, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

P. O. BOX 202737
DALLAS TX
75320-2737
US

V. Phone/Fax

Practice location:
  • Phone: 972-255-5588
  • Fax: 972-255-6688
Mailing address:
  • Phone: 972-701-8826
  • Fax: 972-503-1051

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: DOUGLAS S WON
Title or Position: PHYSICIAN
Credential: MD
Phone: 972-255-5588