Individual
SCOTT B LUNDGREN
Active
Individual
SCOTT B LUNDGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
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
Update your record
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