Provider Demographics
NPI:1598050387
Name:LUNDBERG, CARL STEPHEN (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:STEPHEN
Last Name:LUNDBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 N 500 W
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3705
Mailing Address - Country:US
Mailing Address - Phone:435-770-3560
Mailing Address - Fax:
Practice Address - Street 1:231 N 500 W
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-3705
Practice Address - Country:US
Practice Address - Phone:435-770-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-9249207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology