Healthcare Provider Details

I. General information

NPI: 1861994337
Provider Name (Legal Business Name): LUMIN HEALTH PHYSICIAN GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 TUBBS ROAD
ROCKWALL TX
75032
US

IV. Provider business mailing address

4090 MAPLESHADE LANE SUITE 220
PLANO TX
75093
US

V. Phone/Fax

Practice location:
  • Phone: 972-255-5588
  • Fax: 972-722-1944
Mailing address:
  • Phone: 469-680-4293
  • Fax: 214-313-9272

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