Clark a Gunderson MD AMC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

0124589 Issued in LA

Legal business name

CLARK A GUNDERSON MD AMC

Practice address

2615 Enterprise Blvd
Lake Charles, LA 70601-7686

Phone

(337) 439-0385

Fax

(337) 433-5448

NPI assigned

Mar 1, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Clark A Gunderson, M.D.

Title

President

Phone

(337) 439-0385

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1330560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330560000000",
    "number": "1861766321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 ENTERPRISE BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017686",
            "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": "2615 ENTERPRISE BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017686",
            "telephone_number": "337-439-0385",
            "fax_number": "337-433-5448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK A GUNDERSON MD AMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-01",
        "last_updated": "2012-03-01",
        "status": "A",
        "authorized_official_last_name": "GUNDERSON",
        "authorized_official_first_name": "CLARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-439-0385",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "LA",
            "license": "0124589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114305",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carl William Churchman Jr., DDS
• James Richard Churchman, D.D.S.
• Mary Seale Churchman, DDS
• Sloane Elizabeth Churchman, MS, RD, LDN
• Cathy Marie Clanton, COUNSELOR IN TRAININ
• Courtney Clark, APRN, FNP-C
• Dennis Wayne Clark, CRNA
• Germaine Marie Clark
• Keidra Clark, MSN, RN
• Lakeisha Clark

• Clinic/Center in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; 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.