Provider Demographics
NPI:1376506246
Name:MUNCY, GERALD L JR (MD)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:L
Last Name:MUNCY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:MUNCY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:
Practice Address - Street 1:6501 E GREENWAY PKWY STE 160
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2069
Practice Address - Country:US
Practice Address - Phone:480-948-9903
Practice Address - Fax:480-998-5887
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ20267207Q00000X
WAMD60036841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112467Medicaid
WAPENDINGMedicaid
AZ20267Medicare PIN
WAPENDINGMedicaid
AZ112467Medicaid
WA8878361Medicare PIN