Individual
T. WAYNE MUNRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5201
(740) 446-5761
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5201
(740) 446-5761
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
15270
WV
207P00000X
Emergency Medicine Physician
Primary
35-04-0860
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185056
UNISON MEDICAID
OH
01
—
000000198625
ANTHEM BCBS
—
01
—
000089033
MOUNTAIN STATE BCBS
—
05
—
0051667000
—
WV
01
—
0625694
MOLINA MEDICAID
OH
05
—
0625694
—
OH
01
—
080040488
RR MEDICARE
—
01
—
310917085154
OH MEDICAID CARESOURCE
OH
01
—
P00901249
RAILROAD MEDICARE
OH
Enumeration date
05/27/2006
Last updated
10/24/2011
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