Healthcare Provider Details

I. General information

NPI: 1972090850
Provider Name (Legal Business Name): DU JUN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 N 8TH ST STE 206
GRAND JUNCTION CO
81501-8858
US

IV. Provider business mailing address

2530 N 8TH ST STE 206
GRAND JUNCTION CO
81501-8858
US

V. Phone/Fax

Practice location:
  • Phone: 970-361-2659
  • Fax:
Mailing address:
  • Phone: 970-245-3338
  • Fax: 970-245-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD.0000885
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD.0000885
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: