Individual
ANUNPORN SRISAWAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4554 S CLYDE MORRIS BLVD, SUITE 2, PORT ORANGE, FL 32129-5403
(386) 304-2990
Mailing address
PO BOX 290035, PORT ORANGE, FL 32129-0035
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME 95967
FL
Other
Enumeration date
07/27/2007
Last updated
10/12/2011
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