Provider Demographics
NPI:1104155001
Name:VIJAY K MOHAN MD PA
Entity type:Organization
Organization Name:VIJAY K MOHAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:806-669-3303
Mailing Address - Street 1:104 E 30TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-2822
Mailing Address - Country:US
Mailing Address - Phone:806-669-3303
Mailing Address - Fax:806-669-6611
Practice Address - Street 1:104 E 30TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2822
Practice Address - Country:US
Practice Address - Phone:806-669-3303
Practice Address - Fax:806-669-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5702Medicare PIN