MEDICARE: SAMUEL BRUCE MUNRO D.O.

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	207Q00000X	Family Medicine Physician	K1578	TX

General Provider Information

NPI Number	:	1285639260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL BRUCE MUNRO D.O.

Provider Business Mailing Address
First Line	:	4466 LOCKHILL SELMA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249
Country	:	US
Telephone Number	:	210-694-4081
Fax Number	:	210-696-8053

Provider Business Practice Location Address
First Line	:	4466 LOCKHILL SELMA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249
Country	:	US
Telephone Number	:	210-694-4081
Fax Number	:	210-696-8053

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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