Provider Demographics
NPI:1770825846
Name:MUNDY, ANDREW CARROLL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CARROLL
Last Name:MUNDY
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 1:12416 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:727-547-4700
Mailing Address - Fax:727-394-8661
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:727-547-4700
Practice Address - Fax:727-394-8661
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME149789207X00000X
OH35.125456207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery