Healthcare Provider Details

I. General information

NPI: 1740336338
Provider Name (Legal Business Name): ANNA-LISA M MUNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA-LISA FARMAR MD

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE
AURORA CO
80045-7106
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4597
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-1234
  • Fax:
Mailing address:
  • Phone: 303-602-8340
  • Fax: 303-602-8348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0047579
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: