MEDICARE: WILLIAM A MUNN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	102951	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	196997	OTHER	NC	MEDCOST ID
2	7185841	OTHER	NC	AETNA ID

General Provider Information

NPI Number	:	1053386078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM A MUNN PA

Provider Business Mailing Address
First Line	:	2000 PERIMETER PARK DR STE 200
Second Line	:
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-8442
Country	:	US
Telephone Number	:	984-215-4110
Fax Number	:

Provider Business Practice Location Address
First Line	:	10589 EAST NC 97
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27803
Country	:	US
Telephone Number	:	252-442-1807
Fax Number	:	252-442-1649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	08/07/2021

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Directions to “ WILLIAM A MUNN PA” Practice Location

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