Provider Demographics
NPI:1003103714
Name:PUNG, GEORGIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:L
Last Name:PUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 ALTURAS WAY
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-4140
Mailing Address - Country:US
Mailing Address - Phone:415-383-5904
Mailing Address - Fax:
Practice Address - Street 1:61 CAMINO ALTO
Practice Address - Street 2:STE 108
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2934
Practice Address - Country:US
Practice Address - Phone:415-388-6303
Practice Address - Fax:415-388-7136
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG062572208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics