Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH1672 | FL |
NPI | 1922178664 |
---|---|
Provider Name | Dr. Wolfgang R Munster |
First Address | South Daytona, FL 32119-1951 |
Second Address | South Daytona, FL 32119-1951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89367 | BLUE CROSS BLUE SHIELD # (01) | FL |