1124092804 NPI number — PHILLIP A. MUNOZ MD

Table of content: (NPI 1982888004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124092804 NPI number — PHILLIP A. MUNOZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNOZ
Provider First Name:
PHILLIP
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1124092804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14275 MIDWAY RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-3614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-932-8029
Provider Business Mailing Address Fax Number:
610-271-4245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10330 HICKMAN MILLS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64137-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-412-7004
Provider Business Practice Location Address Fax Number:
816-763-7536
Provider Enumeration Date:
02/17/2006

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: 207ZP0101X , with the licence number:  04-19124 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0101X , with the licence number: R2J39 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 662000006 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1124092804 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 662A00007 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: R2J39 . This is a "MO LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 100124790F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04-19124 . This is a "KANSAS LICENSE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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