Provider Demographics
NPI:1053386078
Name:MUNN, WILLIAM A (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:MUNN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:984-215-4110
Mailing Address - Fax:
Practice Address - Street 1:10589 EAST NC 97
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803
Practice Address - Country:US
Practice Address - Phone:252-442-1807
Practice Address - Fax:252-442-1649
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC196997OtherMEDCOST ID
NC7185841OtherAETNA ID
NCP00430747Medicare PIN
NC196997OtherMEDCOST ID
NCS99482Medicare UPIN