Provider Demographics
NPI:1528121563
Name:HUNG, JERRY BAULOONG (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:BAULOONG
Last Name:HUNG
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 1:4420 LAKE BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7505
Mailing Address - Country:US
Mailing Address - Phone:918-784-1535
Mailing Address - Fax:
Practice Address - Street 1:4420 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:918-784-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01969207RP1001X
FLME98151207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18636OtherBLUE CROSS BLUE SHIELD
FLP00434938OtherRR MEDICARE
NC2010-01969OtherMEDICAL LICENSE
NY229139OtherSTATE MEDICAL LICENSE
FL18636OtherBCBS
FL279560400Medicaid
FL18636OtherBLUE CROSS BLUE SHIELD