Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | 341811-1205 | UT |
Y | 2080P0204X | Pediatric Emergency Doctor | MD162985 | OR |
NPI | 1144301938 |
---|---|
Provider Name | Edward P. Junkins JR. |
First Address | Lebanon, OR 97355-3983 |
Second Address | Lebanon, OR 97355-3983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 01/03/2017 |