Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 00020658 | AL |
NPI | 1194761858 |
---|---|
Provider Name | Siridao Laohasatit Cheng |
First Address | Moulton, AL 35650-0340 |
Second Address | Moulton, AL 35650-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 16/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
540003401 | (05) | AL |
540003994 | (05) | AL |
G64772 | (02) | AL |