Provider Demographics
NPI:1639474026
Name:GUNDEL, WILLIAM ADAM (LMP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ADAM
Last Name:GUNDEL
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 RUDDELL RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5753
Mailing Address - Country:US
Mailing Address - Phone:360-870-9913
Mailing Address - Fax:360-491-1494
Practice Address - Street 1:1240 RUDDELL RD SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5753
Practice Address - Country:US
Practice Address - Phone:360-870-9913
Practice Address - Fax:360-491-1494
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist