Individual
VIMORNWAN SUDHIPONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6500 W NEWBERRY RD, GAINESVILLE, FL 32605-4309
(352) 333-4900
(904) 346-0113
Mailing address
PO BOX 409036, ATLANTA, GA 30384-9036
(352) 369-0948
(904) 346-0113
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME0060722
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26465
BCBS
FL
05
—
377247100
—
FL
05
—
882456662A
—
GA
01
—
930098050
RAILROAD MEDICARE
FL
Enumeration date
07/17/2006
Last updated
03/07/2011
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