MEDICARE: ROBERT C. MUNJAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	12399	MT

General Provider Information

NPI Number	:	1093830515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT C. MUNJAL MD

Provider Business Mailing Address
First Line	:	PO BOX 34439
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1439
Country	:	US
Telephone Number	:	425-525-6694
Fax Number	:	425-525-6700

Provider Business Practice Location Address
First Line	:	902 N ORANGE ST
Second Line	:	SUITE 206
City	:	MISSOULA
State	:	MT
Zip	:	59802-2928
Country	:	US
Telephone Number	:	406-327-3362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	12/27/2010

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