Individual
DR. SRINIVAS MUTYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2625 EXECUTIVE PARK DR, SUITE #4, WESTON, FL 33331-3634
(954) 659-9051
(954) 659-9052
Mailing address
2625 EXECUTIVE PARK DR, SUITE #4, WESTON, FL 33331-3634
(954) 659-9051
(954) 659-9052
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME0076746
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
254938700
—
FL
Enumeration date
01/17/2006
Last updated
04/29/2024
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