Individual
MR. CHATCHAVAL VUTHIGANON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1506 GRAYS HIGHWAY, SUITE C, RIDGELAND, SC 29936
(843) 726-4527
Mailing address
PO BOX 1266, RIDGELAND, SC 29936-2621
(843) 726-4527
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
11376
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113763
—
SC
Enumeration date
05/17/2006
Last updated
07/08/2007
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