Individual
DR. WIJAN PRAPONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19500 SE STARK ST, PORTLAND, OR 97233-5757
(503) 669-3900
Mailing address
19500 SE STARK ST, PORTLAND, OR 97233-5757
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A101420
CA
207R00000X
Internal Medicine Physician
Primary
MD126187
OR
Other
Enumeration date
11/04/2007
Last updated
08/19/2009
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