Provider Demographics
NPI:1639132038
Name:LUNA, GREGORY K (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:K
Last Name:LUNA
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 2242
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-2242
Mailing Address - Country:US
Mailing Address - Phone:509-747-6194
Mailing Address - Fax:509-252-2837
Practice Address - Street 1:217 W CATALDO AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2217
Practice Address - Country:US
Practice Address - Phone:509-747-6194
Practice Address - Fax:509-252-2837
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018252208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1012466Medicaid
WA332124OtherLABOR & INDUSTRIES
WA332124OtherLABOR & INDUSTRIES