Individual
DR. NILS K MUNGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5024
(601) 815-3773
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5024
(601) 815-3773
Taxonomy
Speciality
Code
Description
License number
State
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
Primary
16417
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121091
—
MS
01
—
180041190
RAILROAD MEDICARE
MS
05
—
194374
—
AL
01
—
P00462293
RAILROAD MEDICARE
MS
01
—
P01236791
RAILROAD MEDICARE
MS
Enumeration date
05/28/2006
Last updated
10/08/2018
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