Provider Demographics
NPI:1063676518
Name:DAVULURI, MURALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MURALI
Middle Name:
Last Name:DAVULURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5756
Mailing Address - Country:US
Mailing Address - Phone:985-868-7500
Mailing Address - Fax:985-223-6300
Practice Address - Street 1:1020 LEE AVE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5756
Practice Address - Country:US
Practice Address - Phone:985-868-7500
Practice Address - Fax:985-223-6300
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06662R208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1368750Medicaid
LA1368750Medicaid