Organization
CLARK A GUNDERSON MD AMC
Active
Organization
CLARK A GUNDERSON MD AMC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARK A GUNDERSON M.D. (PRESIDENT)
(337) 439-0385
Entity
Organization
Contact information
Practice address
2615 ENTERPRISE BLVD, LAKE CHARLES, LA 70601-7686
(337) 439-0385
(337) 433-5448
Mailing address
2615 ENTERPRISE BLVD, LAKE CHARLES, LA 70601-7686
(337) 439-0385
(337) 433-5448
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0124589
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114305
—
LA
Enumeration date
03/01/2012
Last updated
03/01/2012
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