Provider Demographics
NPI:1821208497
Name:MISHRA, ANAND DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANAND
Middle Name:DONALD
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:PO BOX 10005
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-2005
Mailing Address - Country:US
Mailing Address - Phone:256-766-2118
Mailing Address - Fax:256-766-2101
Practice Address - Street 1:541 W. COLLEGE STREET
Practice Address - Street 2:SUTIE 1100
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-766-2118
Practice Address - Fax:256-766-2101
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD31249207RC0000X
AL31249207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL132659Medicaid
AL132659Medicaid