Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | CO38614 | CO |
Y | 207XS0117X | Orthopaedic Spine Surgeon | CO38614 | CO |
NPI | 1215982764 |
---|---|
Provider Name | Roger D Sung |
First Address | Colorado Springs, CO 80920-7835 |
Second Address | Colorado Springs, CO 80920-7835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 15/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200040553 | RR MEDICARE (01) | CO |
57955034 | (05) | CO |