Healthcare Provider Details

I. General information

NPI: 1174676464
Provider Name (Legal Business Name): ANDRES J. MUNOZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD WJB DORN VA MEDICAL CENTER
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

6439 GARNERS FERRY RD DEPARTMENT OF MEDICINE
COLUMBIA SC
29209-1638
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax: 803-647-5714
Mailing address:
  • Phone: 803-540-1033
  • Fax: 803-540-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number34326
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34326
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: