Individual
WAROOT SHAY NIMJAREANSUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
701 MEDICAL PLAZA DR, LEESBURG, FL 34748-7313
(352) 273-7002
(352) 273-7388
Mailing address
PO BOX 112727, GAINESVILLE, FL 32611-2727
(352) 273-7002
(352) 273-7388
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
303251
NY
207P00000X
Emergency Medicine Physician
OS17529
FL
207PS0010X
Sports Medicine (Emergency Medicine) Physician
Primary
OS17529
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111181000
—
FL
Enumeration date
05/22/2017
Last updated
04/22/2024
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