MEDICARE: DR. JONATHAN BERGENDAHL LUNDY 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	207XS0106X	Orthopaedic Hand Surgery Physician	18872	ND
2	208600000X	Surgery Physician	054457	GA

General Provider Information

NPI Number	:	1841344678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN BERGENDAHL LUNDY M.D.

Provider Business Mailing Address
First Line	:	3698 CHAMBERS PASS
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7766
Country	:	US
Telephone Number	:	210-539-3219
Fax Number	:

Provider Business Practice Location Address
First Line	:	3698 CHAMBERS PASS
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-7766
Country	:	US
Telephone Number	:	210-539-3219
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	04/11/2023

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