MEDICARE: DR. MAUNG MAUNG OO M.D.

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	207RH0003X	Hematology & Oncology Physician	L0890	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730246208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAUNG MAUNG OO M.D.

Provider Business Mailing Address
First Line	:	721 CLINIC DR
Second Line	:	SUITE A
City	:	TYLER
State	:	TX
Zip	:	75701-2043
Country	:	US
Telephone Number	:	903-592-6152
Fax Number	:	903-526-0629

Provider Business Practice Location Address
First Line	:	115 MEDICAL CIR
Second Line	:	SUITE 106
City	:	ATHENS
State	:	TX
Zip	:	75751-9004
Country	:	US
Telephone Number	:	903-675-1322
Fax Number	:	903-675-6743

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	11/17/2016

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