Individual
PAVANI MUDDASANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
508 S ADAMS ST STE 202, FORT WORTH, TX 76104-2151
(817) 877-3446
(817) 377-6553
Mailing address
PO BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 377-6553
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
M3657
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184525703
—
TX
Enumeration date
12/19/2005
Last updated
11/03/2020
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