Doctor Name: | MR. CHATCHAVAL VUTHIGANON |
NPI Number: | 1891748463 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 11376 |
Business Practice Address: | 1506 Grays Highway Suite C Ridgeland, SC - 29936 |
Business Phone Number: | 8437264527 |
Business Fax Number: | |
Mailing Address: | Po Box 1266, RIDGELAND |
State: | SC |
Postal Code: | 299362621 |
Phone Number: | 8437264527 |
Fax Number: | |
NPI Enumeration Date: | 05/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 11376 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |