1003899659 NPI number — ERIC C LUND MD

Table of content: ERIC C LUND MD (NPI 1003899659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003899659 NPI number — ERIC C LUND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUND
Provider First Name:
ERIC
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003899659
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2015 ALEXANDER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36301-3003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-671-1696
Provider Business Mailing Address Fax Number:
334-794-0721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-793-9511
Provider Business Practice Location Address Fax Number:
334-794-0721
Provider Enumeration Date:
11/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  13554 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X , with the licence number: 13554 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009998815 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 261081700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000059507 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000433793S , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009941466 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000433793R , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009998825 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009998805 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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