Provider Demographics
NPI:1336239888
Name:LUNDELL, RANDY ROY (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:ROY
Last Name:LUNDELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-2410
Mailing Address - Country:US
Mailing Address - Phone:801-504-6117
Mailing Address - Fax:
Practice Address - Street 1:954 N 200 E STE 954
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1247
Practice Address - Country:US
Practice Address - Phone:801-504-6117
Practice Address - Fax:801-504-6328
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5807043-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5807043-1204OtherMEDICAL LISC. #