Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 44060 | MN |
N | 207K00000X | Allergist & Immunologist | L6579 | TX |
N | 207K00000X | Allergist & Immunologist | ME107649 | FL |
N | 207RA0201X | Internist - Allergy & Immunology | L6579 | TX |
N | 2080P0201X | Pediatric Allergist | L6579 | TX |
NPI | 1538111356 |
---|---|
Provider Name | Thanai Pongdee |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 19/08/2020 |