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Individual
MR. KEITH W MUNOZ SR.
Active
Individual
MR. KEITH W MUNOZ SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004279
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
083704148
TRICARE
GA
05
—
299512679C
—
GA
01
—
P001145189
RAILROAD
GA
Enumeration date
06/15/2006
Last updated
06/13/2013
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