Provider Demographics
NPI:1881639565
Name:MUNCIE, HERBERT LEE JR (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:LEE
Last Name:MUNCIE
Suffix:JR
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 1:3541 MOUNT PROSPECT CIR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7588
Mailing Address - Country:US
Mailing Address - Phone:410-591-8999
Mailing Address - Fax:
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-471-2750
Practice Address - Fax:504-471-2764
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200065207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1624233Medicaid
LA4J681F669Medicare PIN
LA1624233Medicaid
LAP00409068Medicare PIN
LA4J681Medicare PIN