Provider Demographics
NPI:1992849483
Name:MUNLY, JAMES C (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:MUNLY
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 1:1660 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-9613
Mailing Address - Country:US
Mailing Address - Phone:503-842-6228
Mailing Address - Fax:
Practice Address - Street 1:1660 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-9613
Practice Address - Country:US
Practice Address - Phone:503-842-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13369MD207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286443Medicaid
ORD80363Medicare UPIN
OR286443Medicaid