Provider Demographics
NPI:1275636474
Name:MISHRA, UDAY S (MD)
Entity Type:Individual
Prefix:MR
First Name:UDAY
Middle Name:S
Last Name:MISHRA
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 1:1305 SE 25TH LOOP STE 103
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6090
Mailing Address - Country:US
Mailing Address - Phone:352-369-5440
Mailing Address - Fax:352-369-4249
Practice Address - Street 1:1305 SE 25TH LOOP
Practice Address - Street 2:SUITE 103
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1030
Practice Address - Country:US
Practice Address - Phone:352-369-5440
Practice Address - Fax:352-369-4249
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 73537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
45402Medicare ID - Type Unspecified
G61117Medicare UPIN