Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 21000 | SC |
N | 207Q00000X | Family Doctor | 75085 | GA |
NPI | 1003810037 |
---|---|
Provider Name | Dr. Leopoldo M Muniz |
First Address | Evans, GA 30809-1967 |
Second Address | Aiken, SC 29803-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 12/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
210007 | (05) | SC |
F65552 | (02) |