=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922005883
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG E MUNGER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2005
-----------------------------------------------------
Last Update Date | 06/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6329 GALL BLVD
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33542-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-788-7616
-----------------------------------------------------
Fax | 813-783-2856
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6329 GALL BLVD
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33542-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-788-7616
-----------------------------------------------------
Fax | 813-783-2856
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME0071209
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207WX0109X
-----------------------------------------------------
Taxonomy Name | Neuro-ophthalmology Physician
-----------------------------------------------------
License Number | ME71209
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207WX0200X
-----------------------------------------------------
Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | ME71209
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------