Provider Demographics
NPI:1275523870
Name:LUND, WILLIAM J (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:LUND
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9484363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
018654600OtherMEDICAL ASSISTANCE
P00147338OtherRR MEDICARE
841S8LUOtherBLUE CROSS BLUE SHIELD
HP41343OtherHEALTH PARTNERS
140987OtherU CARE
1041603OtherPREFERRED ONE
2145442OtherARAZ GROUP AMERICAS PPO
970001907Medicare ID - Type Unspecified
1041603OtherPREFERRED ONE