Provider Demographics
NPI:1063448728
Name:LUNDEBERG, DUANE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:ALLEN
Last Name:LUNDEBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:2222 NW LOVEJOY ST
Practice Address - Street 2:SUITE #622
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3033
Practice Address - Country:US
Practice Address - Phone:503-229-8455
Practice Address - Fax:503-229-7028
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2016-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD11457207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR268284Medicaid
OR26828-5Medicaid
OR26828-5Medicaid
OR187042Medicare PIN
OR268284Medicaid