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Individual

DARYL B LUNDGRIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5301 VIRGINIA WAY, SUITE 300, BRENTWOOD, TN 37027-7541
(615) 221-4474
(615) 234-3774
Mailing address
5301 VIRGINIA WAY, SUITE 300, BRENTWOOD, TN 37027-7541
(615) 221-4474
(615) 234-3774

Taxonomy

Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
MD25297
TN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
43153
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00623235A
GA
01
100022075
PHP OF TN
01
1140001
UNITED HEALTHCARE
01
220018743
RAILROAD MEDICARE
01
264946
BLACK LUNG
01
3031330
BCBS OF TN
TN
05
3383335
TN
05
89063XK
NC
01
PAYSUB
TRIGON
01
TN0101
JOHN DEER
Enumeration date
10/13/2005
Last updated
10/28/2010
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