Provider Demographics
NPI:1184949976
Name:LUNA, GREGORY A (PA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:LUNA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W QUEEN ISABELLA STE C
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2970
Mailing Address - Country:US
Mailing Address - Phone:956-524-0555
Mailing Address - Fax:956-524-0405
Practice Address - Street 1:112 W QUEEN ISABELLA STE C
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-2970
Practice Address - Country:US
Practice Address - Phone:956-524-0555
Practice Address - Fax:956-524-0405
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05710363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1184949976Medicaid