Provider Demographics
NPI:1538169321
Name:LUND, GREG O (MD)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:O
Last Name:LUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2490 S WOODWORTH LOOP 401
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-745-9300
Mailing Address - Fax:907-745-9301
Practice Address - Street 1:2490 S WOODWORTH LOOP 401
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-745-9300
Practice Address - Fax:907-745-9301
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK3376208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1035Medicaid
E58918Medicare UPIN
AKMD1035Medicaid