Individual
JERALD P UNDERDAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1331 N 7TH ST, 100, PHOENIX, AZ 85006-2754
(602) 222-2234
(866) 985-7247
Mailing address
PO BOX 97876, PHOENIX, AZ 85060-7876
(602) 222-2234
(866) 985-7247
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
28541
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
524513
—
AZ
Enumeration date
02/13/2006
Last updated
06/28/2016
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