Provider Demographics
NPI:1457092322
Name:FOGLE, JARUN
Entity Type:Individual
Prefix:
First Name:JARUN
Middle Name:
Last Name:FOGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CHALK LEVEL RD APT E12
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1640
Mailing Address - Country:US
Mailing Address - Phone:984-245-6227
Mailing Address - Fax:
Practice Address - Street 1:901 CHALK LEVEL RD APT E12
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1640
Practice Address - Country:US
Practice Address - Phone:984-245-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31877616344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi