Provider Demographics
NPI:1982795035
Name:LUNDY, JOHN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:LUNDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 EAST HEMLOCK
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030
Mailing Address - Country:US
Mailing Address - Phone:505-546-2705
Mailing Address - Fax:505-546-2706
Practice Address - Street 1:220 EAST HEMLOCK
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030
Practice Address - Country:US
Practice Address - Phone:505-546-2705
Practice Address - Fax:505-546-2706
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83246NM208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM26419Medicaid
NM10001972OtherLOVELACE
NM19817OtherPRESBYTERIAN
NM0389OtherBLUE CROSS
NM0389OtherBLUE CROSS
D35796Medicare UPIN