Healthcare Provider Details

I. General information

NPI: 1841380284
Provider Name (Legal Business Name): JOGY VARGHESE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4163 LOMAC ST
MONTGOMERY AL
36106-2881
US

IV. Provider business mailing address

4163 LOMAC ST
MONTGOMERY AL
36106-2881
US

V. Phone/Fax

Practice location:
  • Phone: 334-396-5570
  • Fax: 334-396-5572
Mailing address:
  • Phone: 337-396-5570
  • Fax: 334-396-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number17288
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: