Provider Demographics
NPI:1356101265
Name:GUNDERSON, GRANT RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:RICHARD
Last Name:GUNDERSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RIVER TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3702
Mailing Address - Country:US
Mailing Address - Phone:701-205-9493
Mailing Address - Fax:
Practice Address - Street 1:2800 10TH AVE N
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0703
Practice Address - Country:US
Practice Address - Phone:406-238-2210
Practice Address - Fax:406-238-2849
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program