Healthcare Provider Details

I. General information

NPI: 1457474355
Provider Name (Legal Business Name): ALBERT R MUNN III MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W JONES ST
RALEIGH NC
27603-1427
US

IV. Provider business mailing address

720 W JONES ST
RALEIGH NC
27603-1427
US

V. Phone/Fax

Practice location:
  • Phone: 919-834-8341
  • Fax: 919-833-6008
Mailing address:
  • Phone: 919-834-8341
  • Fax: 919-833-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number41028
License Number StateNC

VIII. Authorized Official

Name: DR. ALBERT R MUNN III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 919-834-7341