Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G45569 | CA |
NPI | 1003856188 |
---|---|
Provider Name | Dr. Jeffrey Robert Unger |
First Address | Rancho Cucamonga, CA 91739-8939 |
Second Address | Chino, CA 91710-5730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 05/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A50094 | (02) |