Healthcare Provider Details

I. General information

NPI: 1497787485
Provider Name (Legal Business Name): ROBERT E GUNDERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 HARLOW RD SUITE #200
SPRINGFIELD OR
97477-1346
US

IV. Provider business mailing address

PO BOX 53
EUGENE OR
97440
US

V. Phone/Fax

Practice location:
  • Phone: 541-681-8586
  • Fax: 541-681-8587
Mailing address:
  • Phone: 541-681-8586
  • Fax: 541-681-8587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD15793
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: