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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G279	OTHER	TX	BCBS OF TX

General Provider Information

NPI Number	:	1669648341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYDIA A. LUNA, M.D., P.A.

Provider Business Mailing Address
First Line	:	1307 8TH AVE STE 602
Second Line	:
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 STE 602
Second Line	:
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	:	PRESIDENT
Name	:	LYDIA A LUNA
Credential	:	M.D.
Telephone Number	:	817-877-1848

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	05/02/2008

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