Individual
DR. ROBERT VANUDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1506 ASTON AVE, MCCOMB, MS 39648-2735
(601) 249-4282
(601) 249-4852
Mailing address
PO BOX 490, MCCOMB, MS 39649-0490
(601) 249-4282
(601) 249-4852
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
11542
MS
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
11542
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00095703
—
MS
Enumeration date
06/02/2006
Last updated
07/14/2015
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