Provider Demographics
NPI:1366903890
Name:MUDYANADZO, TATENDA ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:TATENDA
Middle Name:ANDREW
Last Name:MUDYANADZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4370 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-4000
Mailing Address - Country:US
Mailing Address - Phone:334-793-5000
Mailing Address - Fax:334-793-5000
Practice Address - Street 1:4370 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4000
Practice Address - Country:US
Practice Address - Phone:334-793-5000
Practice Address - Fax:334-793-5000
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1366903890207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine