Provider Demographics
NPI:1528356565
Name:JUNG, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:JUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:905 N MAIN STE 105
Mailing Address - Street 2:STE 105
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:830-816-5800
Mailing Address - Fax:830-816-5860
Practice Address - Street 1:905 N MAIN STE 105
Practice Address - Street 2:STE 105
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-816-5800
Practice Address - Fax:830-816-5860
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP6652207Q00000X
TXBP10041429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine