Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 13503 | MS |
Y | 208600000X | Surgeon | 13503 | MS |
N | 2082S0105X | Plastic Hand Surgeon | 13503 | MS |
NPI | 1376564021 |
---|---|
Provider Name | Dev Anand Manisundaram |
First Address | Flowood, MS 39232-9303 |
Second Address | Flowood, MS 39232-9303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00116901 | (05) | MS |
G07926 | (02) | MS |