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General NPI Number Information
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NPI Number | 1457921272
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Entity Type | Individual
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Provider Name | BRANT GUNDERSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 315 N WASHINGTON AVE STE 150
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City | COOKEVILLE
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State | TN
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Zip | 38501-2623
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Country | US
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Telephone | 931-525-6676
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Fax | 931-525-6689
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Provider Business Mailing Address
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Address Line | PO BOX 306556
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City | NASHVILLE
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State | TN
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Zip | 37230-6556
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Country | US
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Telephone | 615-329-2294
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Fax | 615-695-1494
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 74455
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License Number State | TN
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