Provider Demographics
NPI:1689749202
Name:MATTHEW D MUNDING, MD, PLLC
Entity Type:Organization
Organization Name:MATTHEW D MUNDING, MD, PLLC
Other - Org Name:MATTHEW MUNDING, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:MUNDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-531-6952
Mailing Address - Street 1:2875 TINA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1581
Mailing Address - Country:US
Mailing Address - Phone:406-728-3366
Mailing Address - Fax:
Practice Address - Street 1:2875 TINA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1581
Practice Address - Country:US
Practice Address - Phone:406-728-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT=========OtherTAX ID NUMBER