Clark A Gunderson, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

012489 Issued in LA

Practice address

1717 Oak Park Blvd FL 3
Lake Charles, LA 70601-8990

Phone

(337) 439-0385

Fax

(337) 433-5448

NPI assigned

Apr 20, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1083831887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2146",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706022146",
            "telephone_number": "337-439-0385",
            "fax_number": "337-433-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 OAK PARK BLVD FL 3",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018990",
            "telephone_number": "337-439-0385",
            "fax_number": "337-433-5448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNDERSON",
        "first_name": "CLARK",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "LA",
            "license": "12489",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "LA",
            "license": "012489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1861766321",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1141305",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3073307",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gulf Coast Teaching Family Services, Inc. (Gulf Coast Social Services, Inc.)
• Gulf Coast Teaching Family Services, Inc. (Gulf Coast Social Services, Inc.)
• Gulf Coast Teaching Family Services, Inc. (Gulf Coast Social Services, Inc.)
• Gulf Coast Teaching Family Services, Inc. (Gulf Coast Social Services, Inc.)
• Gulf Coast Urgent Care
• Justine Gunnell, PHARMD
• Charles Edward Guth, D.D.S.
• Jodie R. Guth, PH.D.
• Delaina Darby Guthrie, DPT
• Julie A Gutierrez, RD

• Orthopaedic Surgery Physician in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Orthopaedic Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.