# CLARK A GUNDERSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1083831887
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 012489 | LA | Yes |
| 207X00000X | Orthopaedic Surgery Physician | 12489 | LA | — |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/20/2007
- **Last updated:** 02/20/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1141305 | — | LA |
| 01 | — | 1861766321 | NPPES | LA |
| 05 | — | 3073307 | — | LA |