Individual provider Active NPI

Leonard L Gunderson, M.D.

  • Radiation Oncology Physician
  • Phoenix, AZ
National Provider Identifier
1265416366
Registry record updated Oct 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
17918 Issued in AZ
Practice address
5779 E Mayo Blvd
Phoenix, AZ 85054-4502
Phone
(480) 301-8000
NPI assigned
Dec 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 17918 AZ Primary

Addresses

Primary practice location

5779 E Mayo Blvd
Phoenix, AZ 85054-4502

Mailing address

5779 E Mayo Blvd
Phoenix, AZ 85054-4502
Phone (480) 301-8000

Other identifiers 2

IdentifierTypeStateIssuer
490350MedicaidAZ
86080015085259A806OtherAZTRIWEST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
17918AZMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193616000000",
    "number": "1265416366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5779 E MAYO BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850544502",
            "telephone_number": "480-301-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5779 E MAYO BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850544502",
            "telephone_number": "480-301-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNDERSON",
        "first_name": "LEONARD",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2007-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "AZ",
            "license": "17918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "490350",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "86080015085259A806",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.