Provider Demographics
NPI:1689654311
Name:LUND, PETER JOHN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:LUND
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 1:1809 GUNBARREL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7185
Mailing Address - Country:US
Mailing Address - Phone:423-893-9020
Mailing Address - Fax:423-893-9040
Practice Address - Street 1:1809 GUNBARREL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7185
Practice Address - Country:US
Practice Address - Phone:423-893-9020
Practice Address - Fax:423-893-9040
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27983207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3801155Medicaid
TN0003725672Medicare NSC
TNG28576Medicare UPIN
TN5198560001Medicare NSC
TN5198560001Medicare NSC