Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | 35104 | MO |
Y | 207RR0500X | Rheumatology | 35104 | MO |
NPI | 1942362777 |
---|---|
Provider Name | Dr. Kongsak Tanphaichitr |
First Address | Florissant, MO 63033-7613 |
Second Address | Florissant, MO 63033-7613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 03/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200861813 | (05) | MO |
A10919 | (02) | MO |