Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 07162 | MS |
N | 208600000X | Surgeon | 07162 | MS |
N | 2082S0105X | Plastic Hand Surgeon | 07162 | MS |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 07162 | MS |
NPI | 1689615486 |
---|---|
Provider Name | Somprasong Songcharoen |
First Address | Madison, MS 39110-6343 |
Second Address | Madison, MS 39110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 19/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D00809 | (02) | MS |