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General NPI Number Information
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NPI Number | 1740423847
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Entity Type | Individual
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Provider Name | MICHAEL JAMES MUNLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 9155 SW BARNES RD STE 735
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City | PORTLAND
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State | OR
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Zip | 97225-6634
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Country | US
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Telephone | 503-297-1351
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Fax | 503-297-2851
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Provider Business Mailing Address
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Address Line | 541 NE 20TH AVE STE 225
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City | PORTLAND
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State | OR
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Zip | 97232-2895
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Country | US
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Telephone | 503-963-2801
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 171532
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | MD171532
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License Number State | OR
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