Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 3538-10 | MS |
NPI | 1043496235 |
---|---|
Provider Name | Dr. Ravi Chandran |
First Address | Jackson, MS 39211 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2008 |
Last Update Date | 08/03/2013 |