Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 5935 | AZ |
N | 111NN0400X | Neurology | 1058 | AZ |
NPI | 1104883164 |
---|---|
Provider Name | Dr. Timothy James Munderloh |
First Address | Flagstaff, AZ 86004 |
Second Address | Flagstaff, AZ 86004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
624131 | UNITED HEALTH CARE (01) | |
AZ0941160 | BCBS (01) | AZ |
U81754 | (02) |