Provider Demographics
NPI:1356398101
Name:MUNRO, T. WAYNE (MD)
Entity type:Individual
Prefix:
First Name:T.
Middle Name:WAYNE
Last Name:MUNRO
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5201
Mailing Address - Fax:740-446-5761
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5201
Practice Address - Fax:740-446-5761
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-0860207P00000X
WV15270207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000089033OtherMOUNTAIN STATE BCBS
WV0051667000Medicaid
OH310917085154OtherOH MEDICAID CARESOURCE
OH000000185056OtherUNISON MEDICAID
OH0625694OtherMOLINA MEDICAID
OH0625694Medicaid
080040488OtherRR MEDICARE
OHP00901249OtherRAILROAD MEDICARE
000000198625OtherANTHEM BCBS
080040488OtherRR MEDICARE
WV0051667000Medicaid