Provider Demographics
NPI:1871539965
Name:LUNOW, DAVID RAY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
Last Name:LUNOW
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 1:3723 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2008
Mailing Address - Country:US
Mailing Address - Phone:817-675-6529
Mailing Address - Fax:
Practice Address - Street 1:504 N RIDGEWAY DR STE C
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5155
Practice Address - Country:US
Practice Address - Phone:817-885-5730
Practice Address - Fax:817-989-2709
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3633207QA0505X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180669701Medicaid
TX0035NSOtherBCBS
TX0035NSOtherBCBS
TXP00333962Medicare PIN
TX180669701Medicaid
TX612471Medicare PIN