Provider Demographics
NPI:1891780771
Name:MUNSON, MARK E
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:MUNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 6TH AVE
Mailing Address - Street 2:STE 340
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-3222
Mailing Address - Country:US
Mailing Address - Phone:913-651-7151
Mailing Address - Fax:913-772-8283
Practice Address - Street 1:1001 6TH AVE
Practice Address - Street 2:STE 340
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3222
Practice Address - Country:US
Practice Address - Phone:913-651-7151
Practice Address - Fax:913-772-8283
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99011207X00000X
KS04-36268207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100089230AMedicaid
FL310057OtherAVMED
FL326359OtherAMERIGROUP
FL4609279OtherAETNA
FL15633601OtherCITRUS HEALTHCARE
FLNPIOtherPHYSICAINS UNITED PLAN
FL410407OtherWELLCARE
FL09 04730OtherUHC
FLME99011OtherLICENSE
FL01361OtherBCBS OF FLORIDA
FL1497748743OtherGROUP NPI NUMBER /LRHSI
FL15042OtherUNIVERSAL HEALTHCARE
FL278877200Medicaid
FL2568340OtherCIGNA
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER
FL278877200Medicaid
FLAF703YMedicare PIN