Provider Demographics
NPI:1386645430
Name:DANDAMUDI, BABU R (MD)
Entity type:Individual
Prefix:DR
First Name:BABU
Middle Name:R
Last Name:DANDAMUDI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2900 LEMAY FERRY RD
Mailing Address - Street 2:STE 104
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-3900
Mailing Address - Country:US
Mailing Address - Phone:314-525-1887
Mailing Address - Fax:314-525-1898
Practice Address - Street 1:2900 LEMAY FERRY RD
Practice Address - Street 2:STE 104
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-3900
Practice Address - Country:US
Practice Address - Phone:314-525-1887
Practice Address - Fax:314-525-1898
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-03-14
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Provider Licenses
StateLicense IDTaxonomies
MO35618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201184900Medicaid
MOA09821Medicare UPIN