Provider Demographics
NPI:1194765552
Name:WON, DOUGLAS S (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:WON
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 202737
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-2737
Mailing Address - Country:US
Mailing Address - Phone:972-255-5588
Mailing Address - Fax:972-255-6688
Practice Address - Street 1:4301 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6497
Practice Address - Country:US
Practice Address - Phone:972-255-5588
Practice Address - Fax:972-255-6688
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9018207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00218970OtherRAILROAD MEDICARE
TX0047LYOtherBLUE CROSS
TX171385101Medicaid
TXP00218970OtherRAILROAD MEDICARE
TXI10492Medicare UPIN