MEDICARE: GREG O LUND MD

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
1	208800000X	Urology Physician	3376	AK

Other Identifiers

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

General Provider Information

NPI Number	:	1538169321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREG O LUND MD

Provider Business Mailing Address
First Line	:	2490 S WOODWORTH LOOP 401
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645
Country	:	US
Telephone Number	:	907-745-9300
Fax Number	:	907-745-9301

Provider Business Practice Location Address
First Line	:	2490 S WOODWORTH LOOP 401
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645
Country	:	US
Telephone Number	:	907-745-9300
Fax Number	:	907-745-9301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	03/24/2008

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