Provider Demographics
NPI:1659420180
Name:LUND, KEITH A
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:LUND
Suffix:
Gender:M
Credentials:
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Other - Credentials:
Mailing Address - Street 1:1060 GAFFNEY RD STE 7440
Mailing Address - Street 2:COMMANDER USA MEDDAC AK MCUC MMD ATTN CREDENTIALS
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7440
Mailing Address - Country:US
Mailing Address - Phone:907-353-5418
Mailing Address - Fax:907-353-4847
Practice Address - Street 1:1060 GAFFNEY RD STE 7440
Practice Address - Street 2:COMMANDER USA MEDDAC AK MCUC MMD ATTN CREDENTIALS
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-7440
Practice Address - Country:US
Practice Address - Phone:907-353-5418
Practice Address - Fax:907-353-4847
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant