Individual
DR. PORNCHAI MOOLSINTONG
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6420 CLAYTON RD, SAINT LOUIS, MO 63117-1811
(314) 768-8250
Mailing address
4 SUNNEN DR, SUITE 120, SAINT LOUIS, MO 63143-3814
(314) 646-1028
(314) 781-4167
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35177
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102590
BLUE CROSS BLUE SHIELD
MO
Enumeration date
02/21/2006
Last updated
07/08/2007
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