Organization
LARRY J MUNDY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY J MUNDY MD PA (OWNER)
(254) 202-8675
Entity
Organization
Contact information
Practice address
3000 HERRING AVE, WACO, TX 76708-3239
(254) 202-8675
(254) 202-6669
Mailing address
PO BOX 20995, WACO, TX 76702-0995
(254) 202-8675
(254) 202-6669
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
H1304
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0085MT
BCBS
TX
Enumeration date
12/05/2007
Last updated
12/05/2007
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