Provider Demographics
NPI:1902179146
Name:LUNDY, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:LUNDY
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:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1727
Mailing Address - Country:US
Mailing Address - Phone:970-243-9340
Mailing Address - Fax:970-241-6894
Practice Address - Street 1:2373 G RD STE 280
Practice Address - Street 2:
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81505-1006
Practice Address - Country:US
Practice Address - Phone:970-243-9340
Practice Address - Fax:970-241-6894
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0052497208600000X
WAMD60285523208600000X
NJ25MA08965800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0297163OtherSTATE L&I
CO65907311Medicaid
WA0300999OtherSTATE L&I
WAG8913044Medicare PIN
COG8854508Medicare PIN
WAG8854508Medicare PIN