Provider Demographics
NPI:1124007166
Name:MUNOZ, RICARDO LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:LUIS
Last Name:MUNOZ
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 1:201 14TH ST SW
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3133
Mailing Address - Country:US
Mailing Address - Phone:727-588-5754
Mailing Address - Fax:727-588-5911
Practice Address - Street 1:201 14TH ST SW
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3133
Practice Address - Country:US
Practice Address - Phone:727-588-5754
Practice Address - Fax:727-588-5911
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60906207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE11177Medicare UPIN
FL14830WMedicare PIN
FL14830TMedicare PIN
FL14830UMedicare PIN