Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | R-10008 | IA |
N | 208600000X | Surgeon | R-10008 | IA |
Y | 208800000X | Urologist | 75144 | WI |
NPI | 1003229055 |
---|---|
Provider Name | Nathan Jung |
First Address | Madison, WI 53716-2257 |
Second Address | Madison, WI 53716-2257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2014 |
Last Update Date | 28/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003229055 | (05) | WI |