# UDOM TINSATUL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1508963950
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 2268 | SD | — |
| 208600000X | Surgery Physician | 3926 | ND | — |
| 208D00000X | General Practice Physician | 3926 | ND | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 03/05/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 12755 | — | ND |
| 01 | — | 1714 | BCBS | ND |
| 01 | — | 450359987 | CHAMPUS | — |
| 01 | — | 450359987000 | WORKERS COMP | ND |
| 05 | — | 7775690 | — | SD |