Provider Demographics
NPI:1679661136
Name:MUENCH, ALAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:G
Last Name:MUENCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 1/2 4TH ST
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4460
Mailing Address - Country:US
Mailing Address - Phone:208-798-7600
Mailing Address - Fax:208-798-7602
Practice Address - Street 1:3316 1/2 4TH ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4460
Practice Address - Country:US
Practice Address - Phone:208-798-7600
Practice Address - Fax:208-798-7602
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-4242208600000X
WAMD00045914208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001204900Medicaid
ID1135521Medicare PIN
IDB63856Medicare UPIN