Individual
GREGORY LYLE JUNGENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1302 RIVER ST, PALATKA, FL 32177-5042
(386) 328-8371
(386) 328-1519
Mailing address
1302 RIVER ST, PALATKA, FL 32177-5042
(386) 326-7342
(386) 325-1086
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1724
FL
363AM0700X
Medical Physician Assistant
PA 1724
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018954700
—
FL
Enumeration date
05/11/2007
Last updated
05/03/2018
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