MEDICARE: DR. ROBERTA GAIL CHUNG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME81856	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00069406	OTHER	FL	RAILROAD MEDICARE NUMBER

General Provider Information

NPI Number	:	1720032840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTA GAIL CHUNG M.D.

Provider Business Mailing Address
First Line	:	17 E OAKLAND AVE
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-2233
Country	:	US
Telephone Number	:	877-423-1330
Fax Number	:	407-877-2166

Provider Business Practice Location Address
First Line	:	17 E OAKLAND AVE
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-2233
Country	:	US
Telephone Number	:	877-423-1330
Fax Number	:	407-877-2166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	10/09/2009

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