Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | E8604 | TX |
NPI | 1225145618 |
---|---|
Provider Name | Dr. Anthony Charles Jung |
First Address | Midlothian, TX 76065-4538 |
Second Address | Dallas, TX 75216-7167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C17658 | (02) | TX |