Individual
JASON BILL GUNDERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3450 POTOMAC WAY, IDAHO FALLS, ID 83404-4970
(208) 557-2900
(208) 557-2910
Mailing address
3450 POTOMAC WAY, IDAHO FALLS, ID 83404-4970
(208) 557-2900
(208) 557-2910
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M-12486
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841501731
—
ID
Enumeration date
06/25/2010
Last updated
04/13/2015
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