Individual
MADHUSUDHANA R MUDDULURU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
2801 FRANCISCAN DR, BRYAN, TX 77802-2544
(979) 776-5967
(979) 731-5916
Mailing address
2800 S TEXAS AVE STE 102, BRYAN, TX 77802-5361
(936) 266-3513
(936) 266-8618
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2012-01567
NC
207R00000X
Internal Medicine Physician
57.015930
OH
208M00000X
Hospitalist Physician
2012-01567
NC
208M00000X
Hospitalist Physician
Primary
P7316
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346472230
—
NC
05
—
1346472230
—
TX
01
—
2012-01567
NC LICENSE
NC
05
—
NC2666
—
SC
Enumeration date
08/11/2009
Last updated
03/20/2024
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