Provider Demographics
NPI:1376506246
Name:MUNCY, GERALD L JR (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:L
Last Name:MUNCY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:MUNCY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:300 N LEE BLVD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5710
Practice Address - Country:US
Practice Address - Phone:928-708-4300
Practice Address - Fax:928-458-2122
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ20267207Q00000X
WAMD60036841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112467Medicaid
WAPENDINGMedicaid
AZ20267Medicare PIN
WAPENDINGMedicaid
AZ112467Medicaid
WA8878361Medicare PIN