1447267000 NPI number — DR. KRAIYUTH VONGXAIBURANA M.D.

Table of content: DR. KRAIYUTH VONGXAIBURANA M.D. (NPI 1447267000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447267000 NPI number — DR. KRAIYUTH VONGXAIBURANA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VONGXAIBURANA
Provider First Name:
KRAIYUTH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447267000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4881 NW 8TH AVE
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32605-4582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-373-6338
Provider Business Mailing Address Fax Number:
352-373-6144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4343 WEST NEWBERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32607-2817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-224-2200
Provider Business Practice Location Address Fax Number:
352-224-2484
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  ME92316 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084S0012X , with the licence number: ME92316 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1065312 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1447267000 . This is a "PHYSICIANS UNITED PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 15484901 . This is a "CITRUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593661648 . This is a "UNIVERSAL HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593661648 . This is a "EVOLUTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1487660247 . This is a "MD MEDICARE CHOICE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 29630 . This is a "COMP OPTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 304355 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29630 . This is a "BC BS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P05944 . This is a "FREEDOM HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2615237 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273660800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00438736 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273660800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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