Provider Demographics
NPI:1134515901
Name:MUNOZ, CHRISTIE DIANNE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:DIANNE
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TX
Mailing Address - Zip Code:76380-2344
Mailing Address - Country:US
Mailing Address - Phone:940-889-5572
Mailing Address - Fax:940-888-1983
Practice Address - Street 1:201 STADIUM DR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TX
Practice Address - Zip Code:76380-2343
Practice Address - Country:US
Practice Address - Phone:940-889-5583
Practice Address - Fax:940-889-8835
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136737207Q00000X
TXS2742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025107900Medicaid