Individual
DR. THERESA AILEEN MUDAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4501
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD22695
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0577260001
DMERC NUMBER
OR
01
—
1407812365
NBMC NPI NUMBER-GROUP
OR
05
—
165468
—
OR
01
—
CD8723
RR MEDICARE GROUP NUMBER
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
12/09/2005
Last updated
10/26/2007
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