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NPI Code Detail

MEDICARE: CHRISTOPHER D GUNDERSON PA-C

MEDICARE: CHRISTOPHER D GUNDERSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA-742ID
2363AM0700XMedical Physician AssistantPA10004402WA

General Provider Information

NPI Number : 1417066143
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER D GUNDERSON PA-C
Provider Business Mailing Address
First Line : PO BOX 191050
Second Line :
City : BOISE
State : ID
Zip : 83719-1050
Country : US
Telephone Number : 208-955-6500
Fax Number :
Provider Business Practice Location Address
First Line : 5601 W CHINDEN BLVD
Second Line :
City : GARDEN CITY
State : ID
Zip : 83714-1463
Country : US
Telephone Number : 208-809-2865
Fax Number : 208-809-2866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2006
Last Update Date : 12/06/2021

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Directions to “ CHRISTOPHER D GUNDERSON PA-C” Practice Location

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