Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 33838 | AZ |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 33838 | AZ |
NPI | 1194727578 |
---|---|
Provider Name | Gerard K Jeong |
First Address | Tucson, AZ 85751-1630 |
Second Address | Tucson, AZ 85712-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 10/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
939390 | (05) | AZ |
I31424 | (02) | |
I31424 | (02) | AZ |