Individual
DR. NIRANDON WONGSURAWAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1015 BOWLES AVE, FENTON, MO 63026-1530
(636) 566-8155
(314) 966-0323
Mailing address
1015 BOWLES AVE, FENTON, MO 63026-1530
(636) 566-8155
(314) 966-0323
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD34919
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205205701
—
MO
Enumeration date
08/16/2006
Last updated
06/29/2010
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