Provider Demographics
NPI:1942434535
Name:JUNG, DANIEL FREDERICK (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:FREDERICK
Last Name:JUNG
Suffix:
Gender:M
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:PO BOX 2443
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2443
Mailing Address - Country:US
Mailing Address - Phone:573-489-6691
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:400 CEDAR ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-3338
Practice Address - Country:US
Practice Address - Phone:573-489-6691
Practice Address - Fax:270-441-4925
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA749672086S0129X, 207P00000X
NY252887-12086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery