Gunderson, Tyler G
Gunderson, Tyler G is an individual health care provider with primary practice located at 118 Brown Ave Ste 103 , Crossville TN 38555. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Gunderson, Tyler G can be contacted via phone (931) 484-8861.Contact Information
Primary practice address
118 Brown Ave Ste 103
Crossville TN 38555
Phone: (931) 484-8861
Fax: (865) 374-2116
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 036-117892 | Illinois |
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 58038 | Tennessee |
Profile Details
| NPI number | 1477765014 |
|---|---|
| LBN Legal business name | Gunderson, Tyler G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 4th, 2007 |
| Last updated | Jun 29th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1477765014 | NPPES |
| Illinois | Other | 036-117892 | PHYSICIAN LICENSE |
| Illinois | Other | K39375 | PHYSICIAN LICENSE |
| Illinois | MEDICAID | Q041304 | PHYSICIAN LICENSE |
| Illinois | MEDICAID | 036117892 | PHYSICIAN LICENSE |
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