Individual
JAG MOHAN S WALIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
320 E FONTANERO ST, COLORADO SPRINGS, CO 80907-7529
(719) 866-6218
Mailing address
320 E FONTANERO ST, COLORADO SPRINGS, CO 80907-7529
(719) 866-6218
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
40287
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
811604
MEDICARE GROUP NUMBER
CO
Enumeration date
07/27/2006
Last updated
11/04/2008
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