Healthcare Provider Details

I. General information

NPI: 1740623842
Provider Name (Legal Business Name): W A MUNSON MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 E LA SALLE ST SUITE M13
COLORADO SPRINGS CO
80909-2274
US

IV. Provider business mailing address

2125 E LA SALLE ST SUITE M13
COLORADO SPRINGS CO
80909-2274
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-3636
  • Fax:
Mailing address:
  • Phone: 719-473-3636
  • Fax:

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: DR. WILLIAM ALBERT MUNSON
Title or Position: OWNER
Credential: MD
Phone: 719-473-3636