Provider Demographics
NPI:1437921210
Name:ANDREW MUNDY MD PLLC
Entity Type:Organization
Organization Name:ANDREW MUNDY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-584-1539
Mailing Address - Street 1:12416 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-3430
Mailing Address - Country:US
Mailing Address - Phone:423-584-1539
Mailing Address - Fax:
Practice Address - Street 1:12416 66TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-3430
Practice Address - Country:US
Practice Address - Phone:423-584-1539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty