Provider Demographics
NPI:1497787485
Name:GUNDERMAN, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:GUNDERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440
Mailing Address - Country:US
Mailing Address - Phone:541-681-8586
Mailing Address - Fax:541-681-8587
Practice Address - Street 1:445 HARLOW RD
Practice Address - Street 2:SUITE #200
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1346
Practice Address - Country:US
Practice Address - Phone:541-681-8586
Practice Address - Fax:541-681-8587
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD157932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR001144Medicaid
WA8402224Medicaid
AKMD5205RMedicaid
AKMD5206RMedicaid
WA8402224Medicaid
AK161139Medicare PIN
ORP00383044Medicare PIN
ORP00105468Medicare PIN
OR119883Medicare PIN
OR001144Medicaid
AKMD5206RMedicaid