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Individual

SCOTT B LUNDGREN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
13215 N 7TH ST STE 100, PHOENIX, AZ 85022-5300
(602) 805-5041
(602) 805-5013
Mailing address
13215 N 7TH ST STE 100, PHOENIX, AZ 85022-5300
(602) 805-5041
(602) 805-5013

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
007093
AZ
207L00000X
Anesthesiology Physician
Primary
36786-21
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
050081894
RAIL ROAD MEDICARE
05
1225011315
WI
05
30066800
WI
05
402744
AZ
Enumeration date
11/22/2005
Last updated
12/03/2024
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