Provider Demographics
NPI:1710005293
Name:FUNG, JAMIE MYHA (DO)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MYHA
Last Name:FUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3163
Mailing Address - Country:US
Mailing Address - Phone:936-634-0526
Mailing Address - Fax:936-634-0529
Practice Address - Street 1:6 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3163
Practice Address - Country:US
Practice Address - Phone:936-634-0526
Practice Address - Fax:936-634-0529
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6757459OtherCIGNA
386708OtherPRONET
86931FOtherBLUECROSS BLUESHIELD
6757459OtherCIGNA
386708OtherPRONET