Provider Demographics
NPI:1679538813
Name:MUNSON, PETER T (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:MUNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVY MEDICINE SUPPORT COMMAND
Mailing Address - Street 2:ATTN: MEDICAL STAFF SERVICES BLDG. H 2005 KNIGHT LANE
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32212-0140
Mailing Address - Country:US
Mailing Address - Phone:904-542-7200
Mailing Address - Fax:843-228-5196
Practice Address - Street 1:1 PINCKNEY BLVD # 6216A
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6122
Practice Address - Country:US
Practice Address - Phone:843-228-5577
Practice Address - Fax:843-228-5196
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT00077Medicaid
E69095Medicare UPIN