Provider Demographics
NPI:1770681447
Name:MUNDY, STEPHANIE B (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:B
Last Name:MUNDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 1240
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:832-355-5575
Mailing Address - Fax:888-876-4946
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 1240
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:832-355-5575
Practice Address - Fax:888-876-4946
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCE1701OtherMEDICARE RAILROAD GROUP
TXP00446772OtherMEDICARE RAILROAD
TX00U85ZOtherMEDICARE GROUP PIN
TXP00446772OtherMEDICARE RAILROAD
TX8J8550Medicare PIN