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General NPI Number Information
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NPI Number | 1972443331
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Entity Type | Individual
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Provider Name | GUNNAR LAVAUR JEPPSON DO
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Gender | Male
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Dates
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Enumeration Date | 03/28/2026
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Last Update Date | 03/28/2026
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Provider Practice Location Address
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Address Line | 300 SINGLETON RIDGE RD
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City | CONWAY
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State | SC
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Zip | 29526-9142
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Country | US
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Telephone | 843-234-7405
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 BURRELL AVE APT 7
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City | LEWISTON
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State | ID
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Zip | 83501-5591
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Country | US
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Telephone | 208-816-9819
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | SC
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