Provider Demographics
NPI:1386671253
Name:JUNG, GREG (CRNA)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MACK LANE
Mailing Address - Street 2:MEDICAL ASSOCIATES CLINIC,LLP
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501
Mailing Address - Country:US
Mailing Address - Phone:605-224-5901
Mailing Address - Fax:605-945-5296
Practice Address - Street 1:100 MACK LANE
Practice Address - Street 2:MEDICAL ASSOCIATES CLINIC,LLP
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501
Practice Address - Country:US
Practice Address - Phone:605-224-5901
Practice Address - Fax:605-945-5296
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR014413367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD65236Medicare ID - Type Unspecified