Provider Demographics
NPI:1003810037
Name:MUNIZ, LEOPOLDO M (MD)
Entity Type:Individual
Prefix:DR
First Name:LEOPOLDO
Middle Name:M
Last Name:MUNIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2510
Mailing Address - Country:US
Mailing Address - Phone:706-922-8274
Mailing Address - Fax:706-922-6695
Practice Address - Street 1:131 RINEHART WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-1703
Practice Address - Country:US
Practice Address - Phone:803-335-2200
Practice Address - Fax:803-649-7966
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA75085207Q00000X
SC21000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC21000OtherLICENSE
SC210007Medicaid
SCBM2946400OtherDEA