Individual
DR. PONNAIAH C. MOHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3125 MATLOCK RD STE 107, ARLINGTON, TX 76015-2905
(817) 899-8109
(888) 878-5157
Mailing address
PO BOX 92, SHANNON, AL 35142-0092
(888) 212-4243
(888) 878-5157
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
M1245
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173763701
—
TX
01
—
8226BO
BLUE CROSS
TX
01
—
P00262936
RR MEDICARE
TX
Enumeration date
08/17/2005
Last updated
06/21/2019
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