Provider Demographics
NPI:1477524403
Name:AMUNDSON, DENNIS EUGENE (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EUGENE
Last Name:AMUNDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:320 SANTA FE DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5138
Mailing Address - Country:US
Mailing Address - Phone:760-632-4269
Mailing Address - Fax:760-632-4256
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE 308
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-632-4269
Practice Address - Fax:760-632-4256
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2012-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4562207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFO1156Medicare UPIN