1609856848 NPI number — DEBRA M MUNCY MD

Table of content: DEBRA M MUNCY MD (NPI 1609856848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609856848 NPI number — DEBRA M MUNCY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNCY
Provider First Name:
DEBRA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609856848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 200993
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77216-0993
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-784-1111
Provider Business Mailing Address Fax Number:
281-784-1555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 SPENCER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-359-2000
Provider Business Practice Location Address Fax Number:
713-359-1004
Provider Enumeration Date:
01/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  H6456 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 135324510 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88477Z . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1609856848 . This is a "TRICARE SOUTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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