Basic Information
| Provider Information | |||||||||
| NPI: | 1497787485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUNDERMAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 53 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416818586 | ||||||||
| FaxNumber: | 5416818587 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 HARLOW RD | ||||||||
| Address2: | SUITE #200 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974771346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416818586 | ||||||||
| FaxNumber: | 5416818587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 01/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD15793 | OR | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 001144 | 05 | OR | MEDICAID | 8402224 | 05 | WA | MEDICAID | MD5205R | 05 | AK | MEDICAID | MD5206R | 05 | AK | MEDICAID |