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NPI Code Detail

MEDICARE: MR. KEITH W MUNOZ SR. P.A.-C

MEDICARE: MR. KEITH W MUNOZ SR. P.A.-C
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
1363A00000XPhysician Assistant004279GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2P001145189OTHERGARAILROAD
3083704148OTHERGATRICARE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437193927
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEITH W MUNOZ SR. P.A.-C
Provider Business Mailing Address
First Line : PO BOX 1276
Second Line :
City : THOMASVILLE
State : GA
Zip : 31799-1276
Country : US
Telephone Number : 229-236-0831
Fax Number : 229-236-0871
Provider Business Practice Location Address
First Line : 100 S MADISON ST
Second Line :
City : THOMASVILLE
State : GA
Zip : 31792-5473
Country : US
Telephone Number : 229-236-0831
Fax Number : 229-236-0871
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 06/13/2013

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