Provider Demographics
NPI:1427021690
Name:MUNSON, BRYCE E (DO)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:E
Last Name:MUNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 E LAKE SAMMAMISH PKWY SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-8914
Mailing Address - Country:US
Mailing Address - Phone:425-688-5488
Mailing Address - Fax:425-369-1435
Practice Address - Street 1:5708 E LAKE SAMMAMISH PKWY SE
Practice Address - Street 2:SUITE 102
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8914
Practice Address - Country:US
Practice Address - Phone:425-688-5488
Practice Address - Fax:425-369-1435
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60105291207Q00000X
NV1150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVI12353Medicare UPIN