Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301086385 | MI |
N | 111NI0900X | Internist | 4301086385 | MI |
N | 207R00000X | Internist | ME106499 | FL |
N | 111NI0900X | Internist | ME106499 | FL |
Y | 207R00000X | Internist | N5268 | TX |
Y | 111NI0900X | Internist | N5268 | TX |
NPI | 1003026410 |
---|---|
Provider Name | Vijaya Mummadi |
First Address | Dallas, TX 75231-0918 |
Second Address | Dallas, TX 75231-0918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 16/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2172397 | (05) | TX |