Provider Demographics
NPI:1720166051
Name:GORDON C. LUNDY
Entity Type:Organization
Organization Name:GORDON C. LUNDY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:415-923-3015
Mailing Address - Street 1:DEPARTMENT LA 22588
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-2588
Mailing Address - Country:US
Mailing Address - Phone:415-923-3015
Mailing Address - Fax:415-923-3501
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:109
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-3015
Practice Address - Fax:415-923-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60433207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty