Healthcare Provider Details

I. General information

NPI: 1003883893
Provider Name (Legal Business Name): WILLIAM A MUNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E FONTANERO ST COLORADO SPRINGS ENDOCRINE CLINIC PC
COLORADO SPRINGS CO
80907-7533
US

IV. Provider business mailing address

325 E FONTANERO ST
COLORADO SPRINGS CO
80907-7533
US

V. Phone/Fax

Practice location:
  • Phone: 719-636-3829
  • Fax: 719-636-1387
Mailing address:
  • Phone: 719-636-3829
  • Fax: 719-636-1387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number14847
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: