Healthcare Provider Details

I. General information

NPI: 1790283778
Provider Name (Legal Business Name): LUMIN HEALTH PHYSICIAN GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4090 MAPLESHADE LN STE 100
PLANO TX
75093-0025
US

IV. Provider business mailing address

4090 MAPLESHADE LN STE 100
PLANO TX
75093-0025
US

V. Phone/Fax

Practice location:
  • Phone: 469-680-4295
  • Fax: 972-265-3001
Mailing address:
  • Phone: 469-680-4295
  • Fax: 972-265-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS S WON
Title or Position: MD
Credential: MD
Phone: 972-255-5588