Individual
MR. MALLIKARJUNA B URMUNDALAVAUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4415 US HIGHWAY 331 S STE A, DEFUNIAK SPRINGS, FL 32435-6307
(850) 682-5332
(850) 682-8486
Mailing address
4415 US HIGHWAY 331 S STE A, DEFUNIAK SPRINGS, FL 32435-6307
(850) 682-5332
(850) 682-8486
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME75135
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34078
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/27/2006
Last updated
07/09/2007
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