Provider Demographics
NPI:1821035205
Name:LUNDY, GORDON C (M D)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:C
Last Name:LUNDY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 WEBSTER ST STE 117
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2374
Mailing Address - Country:US
Mailing Address - Phone:415-923-3015
Mailing Address - Fax:415-923-3501
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 117
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-3015
Practice Address - Fax:415-923-3501
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60433207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE89635Medicare UPIN