Provider Demographics
NPI:1407238207
Name:JUNGWIRTH, GREGORY JOHN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHN
Last Name:JUNGWIRTH
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-5123
Mailing Address - Fax:614-293-4980
Practice Address - Street 1:160 W WILSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2676
Practice Address - Country:US
Practice Address - Phone:614-293-5123
Practice Address - Fax:614-293-4980
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.134331207Q00000X, 207Q00000X
WAML60574269390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program