Provider Demographics
NPI:1568728178
Name:MUNJAMPALLI, JAI P (MD)
Entity Type:Individual
Prefix:
First Name:JAI
Middle Name:P
Last Name:MUNJAMPALLI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1202 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3910
Mailing Address - Country:US
Mailing Address - Phone:318-212-8951
Mailing Address - Fax:318-212-6752
Practice Address - Street 1:1811 E BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 300
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5740
Practice Address - Country:US
Practice Address - Phone:318-212-3636
Practice Address - Fax:318-212-3649
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2019-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA304625208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine