Provider Demographics
NPI:1467560979
Name:JUNGERS, JEFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:JUNGERS
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3700
Mailing Address - Fax:812-234-3565
Practice Address - Street 1:422 POPLAR ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-4209
Practice Address - Country:US
Practice Address - Phone:812-242-3700
Practice Address - Fax:812-234-3565
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032456A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100253780Medicaid
IN100253780DOtherMOLINA HEALTHCARE MCAID
0182858OtherUS DEPT OF LABOR
351904269134OtherCARESOURCE MEDICAID
01398OtherCIGNA
ILP00830678OtherRAILROAD MEDICARE
000000089625OtherANTHEM
149423OtherHEALTHLINK
4062059OtherAETNA
N281074OtherHARMONY HEALTH PLAN IND
180001523OtherRAILROAD MCARE PALAMETTO
I017569C005OtherUNISYS CHAMPUS SECONDARY
000000089625OtherANTHEM
I017569C005OtherUNISYS CHAMPUS SECONDARY
IN192770JJMedicare PIN
4062059OtherAETNA