=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992924443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRYCE H LUND M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 05/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 E MILITARY AVE
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68025-5070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-727-5863
-----------------------------------------------------
Fax | 402-727-7687
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 E MILITARY AVE
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68025-5070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-727-5863
-----------------------------------------------------
Fax | 402-727-7687
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 1732
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 21505
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------