Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 336078174 | IL |
N | 208800000X | Urologist | 37017 | AZ |
NPI | 1043388481 |
---|---|
Provider Name | Dr. Natakom Nash Chulamorkodt |
First Address | Yuma, AZ 85366-2522 |
Second Address | Yuma, AZ 85364-6258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2006 |
Last Update Date | 12/08/2020 |