Individual
DR. MOHAN PENMETCHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4217 MARSH RIDGE RD STE 110, CARROLLTON, TX 75010-4416
(972) 307-3456
(972) 307-6789
Mailing address
4217 MARSH RIDGE RD STE 110, CARROLLTON, TX 75010-4416
(972) 307-3456
(972) 307-6789
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
J9779
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041774305
—
TX
Enumeration date
05/13/2006
Last updated
03/26/2021
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