Healthcare Provider Details

I. General information

NPI: 1609922467
Provider Name (Legal Business Name): T. MURALI MOHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 KENTUCKY AVE
STEVENSON AL
35772-3102
US

IV. Provider business mailing address

PO BOX 920
BRIDGEPORT AL
35740-0920
US

V. Phone/Fax

Practice location:
  • Phone: 256-437-2431
  • Fax: 256-437-8303
Mailing address:
  • Phone: 256-437-2431
  • Fax: 256-437-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11102
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16197
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0029459
Identifier TypeOTHER
Identifier State
Identifier IssuerBCTN
# 2
Identifier4513628
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: