MEDICARE: ALSTON C LUNDGREN M.D.

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
1	207Q00000X	Family Medicine Physician	98-323	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609808005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALSTON C LUNDGREN M.D.

Provider Business Mailing Address
First Line	:	460 ST. MICHAEL'S DR.
Second Line	:	STE. 801
City	:	SANTA FE
State	:	NM
Zip	:	87505
Country	:	US
Telephone Number	:	505-986-0910
Fax Number	:	505-986-0904

Provider Business Practice Location Address
First Line	:	460 SAINT MICHAELS DR
Second Line	:	STE. 801
City	:	SANTA FE
State	:	NM
Zip	:	87505-7619
Country	:	US
Telephone Number	:	505-986-0910
Fax Number	:	505-986-0904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/09/2007

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