Provider Demographics
NPI:1184776973
Name:SUNDIN, T (MD)
Entity type:Individual
Prefix:
First Name:T
Middle Name:
Last Name:SUNDIN
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 1:581 E MAIN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1881
Mailing Address - Country:US
Mailing Address - Phone:541-621-9182
Mailing Address - Fax:541-482-0589
Practice Address - Street 1:581 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2113
Practice Address - Country:US
Practice Address - Phone:541-621-9182
Practice Address - Fax:541-482-0589
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD162342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR111749Medicare ID - Type Unspecified