Provider Demographics
NPI:1972719268
Name:MUNRO, AMY J (DO)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:J
Last Name:MUNRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:840 ROYAL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6461
Practice Address - Country:US
Practice Address - Phone:541-732-8370
Practice Address - Fax:541-732-8371
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO27688208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138457Medicare PIN