Provider Demographics
NPI:1003091729
Name:BLUNDELL, GORDON L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:L
Last Name:BLUNDELL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:179 HWY 22 EAST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447
Mailing Address - Country:US
Mailing Address - Phone:985-845-8101
Mailing Address - Fax:985-845-8130
Practice Address - Street 1:179 HWY 22 EAST
Practice Address - Street 2:SUITE 100
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447
Practice Address - Country:US
Practice Address - Phone:985-845-8101
Practice Address - Fax:985-845-8130
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
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Provider Licenses
StateLicense IDTaxonomies
LA0157642084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry