Provider Demographics
NPI:1467438952
Name:HUNDAHL, SCOTT ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALFRED
Last Name:HUNDAHL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:10535 HOSPITAL WAY # 112
Mailing Address - Street 2:PROFESSOR AND CHIEF OF SURGERY - VA NORTHERN CALIFORNIA
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-4200
Mailing Address - Country:US
Mailing Address - Phone:916-843-7174
Mailing Address - Fax:916-366-5328
Practice Address - Street 1:SACRAMENTO VA MEDICAL CENTER - CHIEF OF SURGERY
Practice Address - Street 2:10535 HOSPITAL WAY, SMAT-112
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-1200
Practice Address - Country:US
Practice Address - Phone:916-843-7174
Practice Address - Fax:916-366-5328
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-07-13
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Provider Licenses
StateLicense IDTaxonomies
CAG866992086X0206X
HIMD-51322086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIE58507Medicare UPIN