Individual
DR. REWADEE SOONTHAROTHAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
303 NORTH CLYDE MORRIS BLVD., HALIFAX HEALTH MEDICAL CENTER, DAYTONA BEACH, FL 32114-2709
(386) 425-2285
(386) 425-7522
Mailing address
303 NORTH CLYDE MORRIS BLVD., HALIFAX HEALTH MEDICAL CENTER, DAYTONA BEACH, FL 32114-2709
(386) 425-2285
(386) 425-7522
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME108326
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002846800
—
FL
01
—
1053583112
TRICARE
FL
01
—
14A24
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
Enumeration date
03/29/2008
Last updated
12/07/2010
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