Healthcare Provider Details

I. General information

NPI: 1992934624
Provider Name (Legal Business Name): CORY ALLEN LUNDBERG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11567 CANTERWOOD BLVD
GIG HARBOR WA
98332-5812
US

IV. Provider business mailing address

11567 CANTERWOOD BLVD
GIG HARBOR WA
98332-5812
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6341
  • Fax: 253-426-6344
Mailing address:
  • Phone: 253-426-6341
  • Fax: 253-426-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOP60729233
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOP60729233
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberOP60729233
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: