Provider Demographics
NPI:1194814913
Name:LUNDSGAARDE, TONYA JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:JOAN
Last Name:LUNDSGAARDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TONYA
Other - Middle Name:JOAN
Other - Last Name:JANSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:22614 NE 192ND CIR
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-9025
Mailing Address - Country:US
Mailing Address - Phone:503-380-1020
Mailing Address - Fax:
Practice Address - Street 1:10180 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-652-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22050207Q00000X
WAMD00037571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine