Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101245677 | VA |
NPI | 1003009119 |
---|---|
Provider Name | Dr. Troy Randolph Mohler |
First Address | Purcellville, VA 20132-6602 |
Second Address | Purcellville, VA 20132-6602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 03/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0907130007 | DME SUPPLIER (01) |