Provider Demographics
NPI:1528171469
Name:MUNERA-CORDOBA, PEDRO ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ANTONIO
Last Name:MUNERA-CORDOBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18679
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-8679
Mailing Address - Country:US
Mailing Address - Phone:601-705-1901
Mailing Address - Fax:
Practice Address - Street 1:103 S 19TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6171
Practice Address - Country:US
Practice Address - Phone:601-544-4641
Practice Address - Fax:228-575-3433
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS173632084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09550215Medicaid
MS260000594Medicare ID - Type Unspecified
MSH78871Medicare UPIN