Healthcare Provider Details

I. General information

NPI: 1508381625
Provider Name (Legal Business Name): ROBERT JAMES GUNDERSON CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 W CHARLESTON BLVD STE 2-6
LAS VEGAS NV
89117-7528
US

IV. Provider business mailing address

10323 SAVANNAH CT
INDEPENDENCE KY
41051-8252
US

V. Phone/Fax

Practice location:
  • Phone: 214-551-0257
  • Fax:
Mailing address:
  • Phone: 214-551-0257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number3330
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: