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General NPI Number Information
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NPI Number | 1528171469
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Entity Type | Individual
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Provider Name | PEDRO ANTONIO MUNERA-CORDOBA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 103 S 19TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-6171
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Country | US
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Telephone | 601-544-4641
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Fax | 228-575-3433
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Provider Business Mailing Address
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Address Line | PO BOX 18679
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City | HATTIESBURG
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State | MS
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Zip | 39404-8679
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Country | US
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Telephone | 601-705-1901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 17363
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License Number State | MS
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