Provider Demographics
NPI:1386938165
Name:LUNDBERG, JOSHUA ERIC (MD, FAAFP)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ERIC
Last Name:LUNDBERG
Suffix:
Gender:M
Credentials:MD, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E CENTRAL DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8046
Mailing Address - Country:US
Mailing Address - Phone:208-795-4357
Mailing Address - Fax:
Practice Address - Street 1:1401 E CENTRAL DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8046
Practice Address - Country:US
Practice Address - Phone:208-795-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2335207Q00000X
TN50570207Q00000X
IDM-12685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine