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General NPI Number Information
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NPI Number | 1508861246
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Entity Type | Individual
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Provider Name | DAVID J GUNDERMAN MD
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Gender | Male
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Dates
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Enumeration Date | 06/18/2005
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 1510 COLUMBUS AVE SUITE 230
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-1899
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Country | US
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Telephone | 740-333-3333
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Fax | 740-636-1196
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Provider Business Mailing Address
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Address Line | 1450 COLUMBUS AVE SUITE 104
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-3701
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Country | US
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Telephone | 740-333-2236
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Fax | 740-333-3881
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35057299
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License Number State | OH
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