Provider Demographics
NPI:1801935481
Name:LLUNCOR, EDGAR (MD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:LLUNCOR
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 3265
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9265
Mailing Address - Country:US
Mailing Address - Phone:323-560-4907
Mailing Address - Fax:323-560-2684
Practice Address - Street 1:4276 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-3524
Practice Address - Country:US
Practice Address - Phone:323-560-4907
Practice Address - Fax:323-560-2684
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37711207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A377110Medicaid
CAA28440Medicare UPIN
CA00A377110Medicaid