Individual
PAVAN TUMMALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
2016026000
MO
2084N0400X
Neurology Physician
Primary
96271
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407111313
—
MO
05
—
200028679
—
MO
Enumeration date
07/06/2012
Last updated
10/18/2023
Update your record
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