Clark A Gunderson MD Amc
Clinic/Center in Lake Charles, LA. Organization (NPI-2).
NPI number1861766321
StatusActive
Last updated in NPPESMar 1, 2012
Details
- NPI
- 1861766321
- Entity type
- Organization (NPI-2)
- Legal business name
- Clark A Gunderson MD Amc
- Organization subpart
- No
- Enumeration date
- Mar 1, 2012
- Last updated
- Mar 1, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | 0124589 | LA | Yes |
Practice location
2615 Enterprise BlvdLake Charles, LA 70601-7686
Phone 337-439-0385 · Fax 337-433-5448
Mailing address
2615 Enterprise BlvdLake Charles, LA 70601-7686
Phone 337-439-0385 · Fax 337-433-5448
Authorized official
Clark A Gunderson
President
3374390385
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