Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 10098 | NH |
NPI | 1063498095 |
---|---|
Provider Name | John Jason Munoz |
First Address | Manchester, NH 03103-3547 |
Second Address | Manchester, NH 03103-3547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 19/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3083972 | (05) | NH |
G43297 | (02) | NH |