Healthcare Provider Details

I. General information

NPI: 1083713937
Provider Name (Legal Business Name): GARY L. MUNCY M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 W 16TH ST
SAFFORD AZ
85546-4048
US

IV. Provider business mailing address

2241 W 16TH ST
SAFFORD AZ
85546-4048
US

V. Phone/Fax

Practice location:
  • Phone: 928-348-1600
  • Fax: 928-348-1603
Mailing address:
  • Phone: 928-348-1600
  • Fax: 928-348-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAZ20267
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP2357
License Number StateAZ

VIII. Authorized Official

Name: MRS. CHARISE GARDNER
Title or Position: BILLING & COLLECTIONS MANAGER
Credential:
Phone: 928-348-1601