Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2012-01374 | NC |
N | 208600000X | Surgeon | 2012-01374 | NC |
N | 208200000X | Surgeon | MD067425L | PA |
N | 208600000X | Surgeon | MD067425L | PA |
Y | 208200000X | Surgeon | ME147205 | FL |
Y | 208600000X | Surgeon | ME147205 | FL |
N | 2086X0206X | Surgical Oncologist | ME147205 | FL |
NPI | 1407842727 |
---|---|
Provider Name | Dr. Paula A Lundgren |
First Address | Clearwater, FL 33759-3012 |
Second Address | Clearwater, FL 33756-3312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017520280003 | (05) | PA |
020051708 | RAILROAD MEDICARE (01) | PA |
109276100 | (05) | FL |
5921261 | (05) | NC |
G89464 | (02) | PA |