Provider Demographics
NPI:1003027376
Name:JUNCK, ANTHONY DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DAVID
Last Name:JUNCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CROSSOVER RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4944
Mailing Address - Country:US
Mailing Address - Phone:662-842-1758
Mailing Address - Fax:662-844-8298
Practice Address - Street 1:620 CROSSOVER RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4944
Practice Address - Country:US
Practice Address - Phone:662-842-1758
Practice Address - Fax:662-844-8298
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS226272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20965Medicaid