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NPI Code Detail

MEDICARE: DANIEL FREDERICK JUNG D.O.

MEDICARE: DANIEL FREDERICK JUNG D.O.
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
12086S0129XVascular Surgery Physician74967GA
22086S0129XVascular Surgery Physician252887-1NY
3207P00000XEmergency Medicine Physician74967GA

General Provider Information

NPI Number : 1942434535
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL FREDERICK JUNG D.O.
Provider Business Mailing Address
First Line : PO BOX 2443
Second Line :
City : STATESBORO
State : GA
Zip : 30459-2443
Country : US
Telephone Number : 573-489-6691
Fax Number : 513-981-5015
Provider Business Practice Location Address
First Line : 400 CEDAR ST
Second Line :
City : METTER
State : GA
Zip : 30439-3338
Country : US
Telephone Number : 573-489-6691
Fax Number : 270-441-4925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2009
Last Update Date : 04/21/2021

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