Individual
DR. MAX A LUNGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1605 MARTIN SPRINGS DR, STE 320, ROLLA, MO 65401-2931
(573) 458-6359
(573) 458-6826
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2011021431
MO
207V00000X
Obstetrics & Gynecology Physician
28735
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619901048
—
MO
05
—
2083642
—
IA
01
—
43-1560263
TRICARE
MO
Enumeration date
07/10/2006
Last updated
03/07/2012
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