Individual
PORNCHAI JONGLERTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 N KANSAS AVE, HASTINGS, NE 68901-4470
(402) 460-5899
(402) 460-5898
Mailing address
815 N KANSAS AVE, HASTINGS, NE 68901-4470
(402) 460-5899
(402) 460-5898
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
15910
MS
207RH0003X
Hematology & Oncology Physician
Primary
24180
NE
207RH0003X
Hematology & Oncology Physician
N0144
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00195
BC/BS INDIVIDUAL NUMBER
NE
05
—
195586601
—
TX
05
—
195586602
—
TX
05
—
195586603
—
TX
01
—
252609
MIDLANDS CHOICE
—
01
—
P00436187
RAILROAD MEDICARE PTAN
—
Enumeration date
02/22/2007
Last updated
09/10/2018
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