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General NPI Number Information
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NPI Number | 1770960973
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Entity Type | Organization
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Legal Business Name | LUMINCARE PHYSICIAN GROUP, PA
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 11350 US HWY 380 SUITE 100
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City | CROSSROADS
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State | TX
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Zip | 76227-6497
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Country | US
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Telephone | 214-296-2945
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Fax | 940-365-9656
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Provider Business Mailing Address
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Address Line | 4090 MAPLESHADE LANE SUITE 220
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City | PLANO
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State | TX
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Zip | 75093-0025
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Country | US
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Telephone | 469-680-4293
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Fax | 214-313-9272
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Authorized Official
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Title or Position | MD
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Name | DOUGLAS S WON
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Credential |
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Telephone | 972-255-5588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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