Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 016012 | CT |
NPI | 1164739967 |
---|---|
Provider Name | Robert Marc Jung |
First Address | Manteo, NC 27954-0640 |
Second Address | Manteo, NC 27954-9466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2010 |
Last Update Date | 01/09/2010 |