=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740280692
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAYMOND J LUNA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2005
-----------------------------------------------------
Last Update Date | 11/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 219 EASTWOOD ST
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77351-3342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-327-7147
-----------------------------------------------------
Fax | 936-327-6234
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 219 EASTWOOD ST
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77351-3342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-328-5213
-----------------------------------------------------
Fax | 936-328-5216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | G5318
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------