Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 2012037438 | MO |
NPI | 1043400104 |
---|---|
Provider Name | Ongkarn Sarasombath |
First Address | Fort Smith, AR 72913-3528 |
Second Address | Fort Smith, AR 72903-4067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 01/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200502490A | (05) | OK |
201021001 | (05) | AR |
310582YUE2 | (02) | AR |
E8112 | MEDICAL LICENSE (01) | AR |