Healthcare Provider Details

I. General information

NPI: 1164494076
Provider Name (Legal Business Name): DR. MICHAEL I MUNFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 NORTHFIELD RD STE 202
CEDAR CITY UT
84721-8623
US

IV. Provider business mailing address

1251 NORTHFIELD RD SUITE 202
CEDAR CITY UT
84721-8622
US

V. Phone/Fax

Practice location:
  • Phone: 435-867-0300
  • Fax: 435-867-0331
Mailing address:
  • Phone: 435-867-0300
  • Fax: 435-867-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4880747-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier870673778MUN
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerEMIA
# 2
Identifier63237
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerPEHP
# 3
Identifier48807471201001
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerBCBS
# 4
Identifier687379
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerDMBA
# 5
Identifier107004053101
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerIHC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: