Healthcare Provider Details

I. General information

NPI: 1033524574
Provider Name (Legal Business Name): DR. ERIK LUNDBERG ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOONE RD
BREMERTON WA
98312-1894
US

IV. Provider business mailing address

2134 ROWELL RD
QUANTICO VA
22134-5191
US

V. Phone/Fax

Practice location:
  • Phone: 360-475-4339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number0101258810
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101258810
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: