MEDICARE: LYDIA A LUNA M.D., P. A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	G1465	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00G279	OTHER	TX	MEDICARE ID #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G279	OTHER	TX	BCBS
3	2937634	OTHER	TX	CIGNA
4	4133080	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1043288590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA A LUNA M.D., P. A.

Provider Business Mailing Address
First Line	:	1307 8TH AVE
Second Line	:	#602
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4143
Country	:	US
Telephone Number	:	817-877-1848
Fax Number	:	817-877-3716

Provider Business Practice Location Address
First Line	:	1307 8TH AVE
Second Line	:	#602
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4143
Country	:	US
Telephone Number	:	817-877-1848
Fax Number	:	817-877-3716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	06/26/2013

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