Healthcare Provider Details

I. General information

NPI: 1447249941
Provider Name (Legal Business Name): JOSE C MUNIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 THOMAS JOHNSON DR SUITE 100
FREDERICK MD
21702-4386
US

IV. Provider business mailing address

178 THOMAS JOHNSON DR SUITE 100
FREDERICK MD
21702-4386
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number0720786
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: