Provider Demographics
NPI:1063464485
Name:MUNT, ROBERT LAWRENCE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:MUNT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4414 LAKE BOONE TRAIL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607
Mailing Address - Country:US
Mailing Address - Phone:919-787-0266
Mailing Address - Fax:919-571-9314
Practice Address - Street 1:4414 LAKE BOONE TRAIL
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-787-0266
Practice Address - Fax:919-571-9314
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-09-26
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Provider Licenses
StateLicense IDTaxonomies
NC21831208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012U3OtherBCBS
NC79012U3Medicaid
H17432Medicare UPIN