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General NPI Number Information
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NPI Number | 1891786588
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Entity Type | Individual
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Provider Name | L. JOHN KLUNK MD
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 15 FREETOWN RD
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City | RAYMOND
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State | NH
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Zip | 03077-2358
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Country | US
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Telephone | 603-895-8000
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Fax | 603-895-8099
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Provider Business Mailing Address
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Address Line | 15 FREETOWN RD
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City | RAYMOND
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State | NH
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Zip | 03077-2358
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Country | US
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Telephone | 603-895-8000
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Fax | 603-895-8099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 11322
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 11300
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License Number State | NH
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