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NPI Code Detail

MEDICARE: DR. VICTOR H GUNDERSON JR. M.D.

MEDICARE: DR. VICTOR H GUNDERSON JR. M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician011508LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407800824
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VICTOR H GUNDERSON JR. M.D.
Provider Business Mailing Address
First Line : PO BOX 52545
Second Line :
City : LAFAYETTE
State : LA
Zip : 70505-2545
Country : US
Telephone Number : 337-289-2180
Fax Number : 337-289-2677
Provider Business Practice Location Address
First Line : 611 SAINT LANDRY ST
Second Line :
City : LAFAYETTE
State : LA
Zip : 70506-4627
Country : US
Telephone Number : 337-289-2180
Fax Number : 337-289-2677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 03/28/2008

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