Healthcare Provider Details

I. General information

NPI: 1306572318
Provider Name (Legal Business Name): TIMOTHY MERRILL LUND PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8141 W CAMELBACK RD # B-101
PHOENIX AZ
85033-1050
US

IV. Provider business mailing address

261 N ROOSEVELT AVE
CHANDLER AZ
85226-2617
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax: 480-535-0962
Mailing address:
  • Phone: 480-677-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9729
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: