Provider Demographics
NPI:1790407286
Name:GUNDERSON, STEVEN GORDON (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:GORDON
Last Name:GUNDERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 N JOHN B DENNIS HWY APT 1901
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-0828
Mailing Address - Country:US
Mailing Address - Phone:507-589-9271
Mailing Address - Fax:
Practice Address - Street 1:6890 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8610
Practice Address - Country:US
Practice Address - Phone:423-839-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant