Provider Demographics
NPI:1457329211
Name:MUNNS, EARLE C (DO)
Entity Type:Individual
Prefix:
First Name:EARLE
Middle Name:C
Last Name:MUNNS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 12TH ST E
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-1718
Mailing Address - Country:US
Mailing Address - Phone:817-455-6927
Mailing Address - Fax:
Practice Address - Street 1:808 12TH ST E
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1718
Practice Address - Country:US
Practice Address - Phone:817-455-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN437480000Medicaid
MN0080015918Medicare NSC