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General NPI Number Information
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NPI Number | 1164477824
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Entity Type | Individual
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Provider Name | MATTHEW D MUNDING M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 2825 FORT MISSOULA RD SUTIE 301
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City | MISSOULA
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State | MT
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Zip | 59804-7420
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Country | US
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Telephone | 406-926-6999
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Fax | 406-926-6999
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Provider Business Mailing Address
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Address Line | 5751 MEADOW VISTA DR
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City | FLORENCE
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State | MT
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Zip | 59833-6602
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Country | US
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Telephone | 406-531-6952
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 9973
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License Number State | MT
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