Provider Demographics
NPI:1568481588
Name:MUNYON, THOMAS GEORGE
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GEORGE
Last Name:MUNYON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:GEORGE
Other - Last Name:MUNYON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3060 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1512
Mailing Address - Country:US
Mailing Address - Phone:650-654-6020
Mailing Address - Fax:650-654-6025
Practice Address - Street 1:262 REDWOOD SHORES PKWY
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94065-1172
Practice Address - Country:US
Practice Address - Phone:650-654-6020
Practice Address - Fax:650-654-6025
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30666174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A306660Medicare ID - Type Unspecified