Healthcare Provider Details

I. General information

NPI: 1083817548
Provider Name (Legal Business Name): MATTHEW RUSSELL MUENSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 N GATEWAY BLVD STE 101
FRESNO CA
93727-1679
US

IV. Provider business mailing address

PO BOX 840294
DALLAS TX
75284-0294
US

V. Phone/Fax

Practice location:
  • Phone: 559-216-0078
  • Fax: 559-471-3940
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberN5892
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberN5892
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME101586
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA109789
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA109789
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME101586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: