Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 11662 | NV |
Y | 2086S0129X | Vascular Surgeon | ME70243 | FL |
NPI | 1124172622 |
---|---|
Provider Name | Vasana Cheanvechai |
First Address | Fort Lauderdale, FL 33308-4510 |
Second Address | Fort Lauderdale, FL 33308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 09/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100508393 | (05) | NV |
CC1844 | ANTHEM BLUE C & BLUE S (01) | NV |
H54607 | (02) | NV |