Individual
DR. TYLER G GUNDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
118 BROWN AVE STE 103, CROSSVILLE, TN 38555
(931) 484-8861
(865) 374-2116
Mailing address
118 BROWN AVE STE 103, CROSSVILLE, TN 38555-7740
(931) 484-8861
(865) 374-2116
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036-117892
IL
207X00000X
Orthopaedic Surgery Physician
Primary
58038
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-117892
PHYSICIAN LICENSE
IL
05
—
036117892
—
IL
01
—
K39375
MEDICARE
IL
05
—
Q041304
—
TN
Enumeration date
05/04/2007
Last updated
06/29/2020
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