Provider Demographics
NPI:1972800787
Name:DORIS C GUNDERSEN M D P C
Entity type:Organization
Organization Name:DORIS C GUNDERSEN M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:GUNDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-717-8516
Mailing Address - Street 1:425 S CHERRY ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1226
Mailing Address - Country:US
Mailing Address - Phone:303-717-8516
Mailing Address - Fax:303-738-0644
Practice Address - Street 1:425 S CHERRY ST
Practice Address - Street 2:SUITE 810
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1226
Practice Address - Country:US
Practice Address - Phone:303-717-8516
Practice Address - Fax:303-738-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO304522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841311057OtherNPI
1841311057OtherNPI