Provider Demographics
NPI:1982607529
Name:MUNOZ, ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5732
Mailing Address - Country:US
Mailing Address - Phone:307-262-1408
Mailing Address - Fax:
Practice Address - Street 1:144 S 21ST ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5732
Practice Address - Country:US
Practice Address - Phone:307-262-1408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6217A208G00000X
IN01089616A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114320400OtherWYOMING MEDICAID
WY780001530OtherRAILROAD MEDICARE
WY114320400Medicaid
WY308054OtherBLUE SHIELD
WY308054OtherBLUE SHIELD
WY114320400Medicaid
WY780001530OtherRAILROAD MEDICARE