Provider Demographics
NPI:1417926056
Name:MUNOZ, JOHNATHON R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHON
Middle Name:R
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHNNY
Other - Middle Name:R
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-213-6235
Mailing Address - Fax:928-213-6292
Practice Address - Street 1:3700 W STATE ROUTE 89A
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4937
Practice Address - Country:US
Practice Address - Phone:928-204-4100
Practice Address - Fax:928-204-4115
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 113250207P00000X
AZ52306207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009998225Medicaid
051529486OtherBLUE CROSS BLUE SHIELD
H06055Medicare UPIN
051556153Medicare ID - Type Unspecified