Provider Demographics
NPI:1356843825
Name:LUMINCARE PHYSICIAN GROUP, PA
Entity Type:Organization
Organization Name:LUMINCARE PHYSICIAN GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-255-5588
Mailing Address - Street 1:4090 MAPLESHADE LANE SUITE 220
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-0025
Mailing Address - Country:US
Mailing Address - Phone:469-680-4293
Mailing Address - Fax:214-313-9272
Practice Address - Street 1:210 N CUSTER ROAD SUITE 100
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071
Practice Address - Country:US
Practice Address - Phone:972-646-0960
Practice Address - Fax:214-592-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty