Provider Demographics
NPI:1164494076
Name:MUNFORD, MICHAEL I
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:I
Last Name:MUNFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 NORTHFIELD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-8622
Mailing Address - Country:US
Mailing Address - Phone:435-867-0300
Mailing Address - Fax:435-867-0331
Practice Address - Street 1:1251 NORTHFIELD RD
Practice Address - Street 2:STE 202
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8623
Practice Address - Country:US
Practice Address - Phone:435-867-0300
Practice Address - Fax:435-867-0331
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4880747-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870673778MUNOtherEMIA
UT63237OtherPEHP
UT48807471201001OtherBCBS
UT687379OtherDMBA
UT107004053101OtherIHC
UT63237OtherPEHP
UT870673778MUNOtherEMIA