Provider Demographics
NPI:1417926031
Name:LUNA, JORGE D (DO)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:D
Last Name:LUNA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 EXECUTIVE WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3946
Mailing Address - Country:US
Mailing Address - Phone:877-868-4827
Mailing Address - Fax:
Practice Address - Street 1:3720 EXECUTIVE WAY STE 106
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3946
Practice Address - Country:US
Practice Address - Phone:877-868-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 4464207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
82485UOtherMEDICARE
FL82485WMedicare ID - Type Unspecified