Individual
DR. PORNTHEP WATTANAMANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
C186338
CA
207RI0200X
Infectious Disease Physician
C186338
CA
207RI0200X
Infectious Disease Physician
Primary
L5950
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157125902
—
TX
01
—
8R0570
BLUE CROSS BLUE SHIELD
TX
01
—
P00193508
RAILROAD MEDICARE
TX
Enumeration date
05/31/2005
Last updated
09/29/2023
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