Healthcare Provider Details

I. General information

NPI: 1306471511
Provider Name (Legal Business Name): JUGERT BANGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GERMANTOWN RD
GERMANTOWN TN
38138-2205
US

IV. Provider business mailing address

PO BOX 18698
BELFAST ME
04915-4081
US

V. Phone/Fax

Practice location:
  • Phone: 901-759-3100
  • Fax: 901-759-3196
Mailing address:
  • Phone: 901-759-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number77547
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: