Provider Demographics
NPI:1356455497
Name:SY, LUNA U (MD)
Entity Type:Individual
Prefix:
First Name:LUNA
Middle Name:U
Last Name:SY
Suffix:
Gender:F
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 190
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36361-0190
Mailing Address - Country:US
Mailing Address - Phone:334-445-9101
Mailing Address - Fax:334-445-3501
Practice Address - Street 1:324 WHITE AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-0908
Practice Address - Country:US
Practice Address - Phone:334-445-9101
Practice Address - Fax:334-445-3501
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009998295Medicaid
AL009998295Medicaid
ALG18661Medicare UPIN