Individual
DR. CHANDLER VIMAL MOHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4812 W US HIGHWAY 90, LAKE CITY, FL 32055-5126
(386) 466-1106
(386) 466-1821
Mailing address
PO BOX 1646, LAKE CITY, FL 32056-1646
(386) 466-1106
(386) 466-1821
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
0101243179
VA
207VG0400X
Gynecology Physician
ME101708
FL
207VX0000X
Obstetrics Physician
ME101708
FL
208D00000X
General Practice Physician
0101243179
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002878500
—
FL
05
—
1629239561
—
VA
Enumeration date
06/23/2008
Last updated
11/04/2016
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