Provider Demographics
NPI:1780606087
Name:GREG O. LUND, M.D.
Entity type:Organization
Organization Name:GREG O. LUND, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DISCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-745-9300
Mailing Address - Street 1:2490 S WOODWORTH LOOP
Mailing Address - Street 2:401
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-745-9300
Mailing Address - Fax:907-745-9301
Practice Address - Street 1:2490 S WOODWORTH LOOP
Practice Address - Street 2:401
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-745-9300
Practice Address - Fax:907-745-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3376208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK151600Medicare ID - Type UnspecifiedGROUP NUMBER