Provider Demographics
NPI:1619018678
Name:LUNA BECK MD & ASSOCIATES PA
Entity type:Organization
Organization Name:LUNA BECK MD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUNA
Authorized Official - Middle Name:BELLA
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-307-7940
Mailing Address - Street 1:17820 SE 109TH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8968
Mailing Address - Country:US
Mailing Address - Phone:352-307-7940
Mailing Address - Fax:352-307-7941
Practice Address - Street 1:17820 SE 109TH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8968
Practice Address - Country:US
Practice Address - Phone:352-307-7940
Practice Address - Fax:352-307-7941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1790742062OtherINDIVIDAUL NPI NUMBER
FLI03494Medicare UPIN
FL1790742062OtherINDIVIDAUL NPI NUMBER