Healthcare Provider Details

I. General information

NPI: 1629527148
Provider Name (Legal Business Name): ROBERT LUND ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 S EASTERN AVE SUITE 124
LAS VEGAS NV
89123-1550
US

IV. Provider business mailing address

20 E AIRPORT RD # 111 #111
LEBANON OR
97355-3094
US

V. Phone/Fax

Practice location:
  • Phone: 541-401-4013
  • Fax: 541-451-4673
Mailing address:
  • Phone: 541-401-4013
  • Fax: 541-451-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number060704
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number060704
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number06704
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: