Healthcare Provider Details

I. General information

NPI: 1316940893
Provider Name (Legal Business Name): JEFFREY LUNDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date: 03/17/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

200 W CHURCH ST
LEXINGTON TN
38351-2038
US

IV. Provider business mailing address

200 W CHURCH ST
LEXINGTON TN
38351-2038
US

V. Phone/Fax

Practice location:
  • Phone: 731-968-3646
  • Fax: 731-968-1870
Mailing address:
  • Phone: 731-968-3646
  • Fax: 731-968-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD16241
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: