Provider Demographics
NPI:1225035827
Name:LU, MING (MD)
Entity Type:Individual
Prefix:DR
First Name:MING
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6095
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:1327 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4443
Practice Address - Country:US
Practice Address - Phone:903-531-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90506207W00000X
TXL7021207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V5494OtherBCBS
TX159151305Medicaid
TXTIN PLUS 021OtherTRICARE
TXP00853786Medicare PIN
CAZZZ13274ZMedicare ID - Type Unspecified
TXTXB107014Medicare Oscar/Certification
TXTIN PLUS 021OtherTRICARE