Provider Demographics
NPI:1568644755
Name:JOHN R. MUNRO M.D.
Entity Type:Organization
Organization Name:JOHN R. MUNRO M.D.
Other - Org Name:ANDERSON WALK-IN MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-365-4412
Mailing Address - Street 1:2760 BALLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3537
Mailing Address - Country:US
Mailing Address - Phone:530-365-4412
Mailing Address - Fax:530-365-5186
Practice Address - Street 1:2760 BALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3537
Practice Address - Country:US
Practice Address - Phone:530-365-4412
Practice Address - Fax:530-365-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA553862Medicare Oscar/Certification