Provider Demographics
NPI:1447284807
Name:MUNOZ, DAVID R (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 N ALDER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-6227
Mailing Address - Country:US
Mailing Address - Phone:253-759-8925
Mailing Address - Fax:
Practice Address - Street 1:316 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:SUITE 304
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4252
Practice Address - Country:US
Practice Address - Phone:253-272-5076
Practice Address - Fax:253-272-5643
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017592174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA28996OtherL & I
WA1067719Medicaid
WAMD00017592OtherBUSINESS LICENSE
WAMD00017592OtherBUSINESS LICENSE
WA28996OtherL & I
WAA08535Medicare UPIN