Basic Information
| Provider Information | |||||||||
| NPI: | 1609856848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNCY | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 200993 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772160993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817841111 | ||||||||
| FaxNumber: | 2817841555 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 SPENCER HWY | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775041202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133592000 | ||||||||
| FaxNumber: | 7133591004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2006 | ||||||||
| LastUpdateDate: | 11/24/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | H6456 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 135324510 | 05 | TX | MEDICAID | 88477Z | 01 | TX | BC/BS PROVIDER NUMBER | OTHER | 1609856848 | 01 | TX | TRICARE SOUTH | OTHER |