Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 11796 | NV |
N | 207X00000X | Orthopaedic Surgeon | A94028 | CA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 11796 | NV |
NPI | 1720036270 |
---|---|
Provider Name | Gregory Andrew Lundeen |
First Address | Reno, NV 89503-4723 |
Second Address | Reno, NV 89503-4723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100510206 | (05) | NV |
11609986 | CAQH (01) | |
I15636 | (02) | NV |