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Individual
CHANDLER FOUNTAIN
Active
Individual
CHANDLER FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101278936
VA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
0101278936
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2017
Last updated
09/21/2026
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