Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME127511 | FL |
NPI | 1427342203 |
---|---|
Provider Name | Dr. Chetan Vedvyas |
First Address | Fort Myers, FL 33912-4318 |
Second Address | Punta Gorda, FL 33950-3833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2011 |
Last Update Date | 16/05/2018 |