Healthcare Provider Details

I. General information

NPI: 1013926658
Provider Name (Legal Business Name): JOSE C. MUNIZ, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 THOMAS JOHNSON DR
FREDERICK MD
21702-4386
US

IV. Provider business mailing address

178 THOMAS JOHNSON DR
FREDERICK MD
21702-4386
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-1244
  • Fax: 301-662-0552
Mailing address:
  • Phone: 301-662-1244
  • Fax: 301-662-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0020786
License Number StateMD

VIII. Authorized Official

Name: DR. JOSE C MUNIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 301-662-1244