Basic Information
Provider Information | |||||||||
NPI: | 1922005883 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MUNGER | ||||||||
FirstName: | CRAIG | ||||||||
MiddleName: | E | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6329 GALL BLVD | ||||||||
Address2: |   | ||||||||
City: | ZEPHYRHILLS | ||||||||
State: | FL | ||||||||
PostalCode: | 335422515 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8137887616 | ||||||||
FaxNumber: | 8137832856 | ||||||||
Practice Location | |||||||||
Address1: | 6329 GALL BLVD | ||||||||
Address2: |   | ||||||||
City: | ZEPHYRHILLS | ||||||||
State: | FL | ||||||||
PostalCode: | 335422515 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8137887616 | ||||||||
FaxNumber: | 8137832856 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/06/2005 | ||||||||
LastUpdateDate: | 06/03/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/03/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME0071209 | FL | N |   | Allopathic & Osteopathic Physicians | Ophthalmology |   | 207WX0109X | ME71209 | FL | N |   |   |   |   | 207WX0200X | ME71209 | FL | Y |   |   |   |   |
ID Information
ID | Type | State | Issuer | Description | 31542 | 01 | FL | BCBS FLORIDA | OTHER | 0498746 | 01 | NY | GHI | OTHER | 250497900 | 05 | FL |   | MEDICAID | 0805199 | 01 | FL | UNITED HEALTHCARE | OTHER | 2074404 | 01 | FL | AETNA | OTHER | 5127315 | 01 | FL | AETNA | OTHER |