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Individual

PAUL E LUNDSTROM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
77 W FOREST AVE, SUITE 201, FLAGSTAFF, AZ 86001-1479
(928) 773-2222
(928) 773-2598
Mailing address
PO BOX 10577, SCOTTSDALE, AZ 85271-0577
(928) 773-2222
(928) 773-2598

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
8740
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
202226
AZ
01
AZ0801620
BLUE CROSS BLUE SHIELD AZ
AZ
Enumeration date
03/14/2006
Last updated
01/25/2008
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