Healthcare Provider Details

I. General information

NPI: 1801868856
Provider Name (Legal Business Name): PETER W JUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 10/28/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MOORE RD
KING NC
27021-8703
US

IV. Provider business mailing address

2000 FRONTIS PLAZA BLVD STE 200 ATTN FORSYTH MEDICAL GROUP
WINSTON SALEM NC
27103-5616
US

V. Phone/Fax

Practice location:
  • Phone: 336-983-4346
  • Fax:
Mailing address:
  • Phone: 336-277-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9401426
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: