Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 006388 | AZ |
N | 111NI0900X | Internist | 006388 | AZ |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 006388 | AZ |
NPI | 1205027836 |
---|---|
Provider Name | Dr. Jeffrey Quincy Munro |
First Address | Phoenix, AZ 85032-2139 |
Second Address | Avondale, AZ 85392-5010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 20/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1205027836 | NPI (01) | AZ |
407831 | (05) | AZ |
Z229272 | MEDICARE (01) | AZ |