Provider Demographics
NPI:1679599617
Name:MUNDEN, PAUL M (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:MUNDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51568
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-1568
Mailing Address - Country:US
Mailing Address - Phone:806-352-3157
Mailing Address - Fax:806-358-0041
Practice Address - Street 1:3501 S SONCY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6407
Practice Address - Country:US
Practice Address - Phone:806-352-3157
Practice Address - Fax:806-355-9885
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH2633207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133172004Medicaid
TX00122JMedicare PIN
TX133172004Medicaid