Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 27252 | NE |
NPI | 1023379369 |
---|---|
Provider Name | Travis J Junge |
First Address | O Fallon, IL 62269-2579 |
Second Address | O Fallon, IL 62269-1282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2012 |
Last Update Date | 30/12/2021 |