Provider Demographics
NPI:1770551103
Name:LUONG, BEN (MD)
Entity type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:LUONG
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 1:1110 N 13TH ST
Mailing Address - Street 2:SPACE #10
Mailing Address - City:LAMESA
Mailing Address - State:TX
Mailing Address - Zip Code:79331-3000
Mailing Address - Country:US
Mailing Address - Phone:806-740-5939
Mailing Address - Fax:
Practice Address - Street 1:1313 COUNTY ROAD 19
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331-1817
Practice Address - Country:US
Practice Address - Phone:806-872-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8942207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH22828Medicare UPIN