Healthcare Provider Details

I. General information

NPI: 1780011270
Provider Name (Legal Business Name): RICHARD A. MUNGER M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PAULINE CT
SONORA CA
95370-5210
US

IV. Provider business mailing address

1000 GREENLEY RD
SONORA CA
95370-5200
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-5154
  • Fax: 209-532-5007
Mailing address:
  • Phone: 209-536-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD ALAN MUNGER
Title or Position: PHYSICIAN
Credential: MD
Phone: 209-532-5154