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General NPI Number Information
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NPI Number | 1205862554
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Entity Type | Individual
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Provider Name | DOUGLAS A MUNRO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 121 SOTOYOME ST
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City | SANTA ROSA
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State | CA
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Zip | 95405-4823
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Country | US
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Telephone | 707-546-4062
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Fax | 707-525-4095
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Provider Business Mailing Address
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Address Line | PO BOX 5651
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City | ORANGE
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State | CA
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Zip | 92863-5651
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Country | US
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Telephone | 714-571-5000
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Fax | 714-571-5055
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G62428
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License Number State | CA
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