Individual
DR. CHOTCHAI BOONKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3478 BRIDGELAND DR, SUITE 1, BRIDGETON, MO 63044-2619
(314) 291-3717
(314) 291-1671
Mailing address
3478 BRIDGELAND DR, SUITE 1, BRIDGETON, MO 63044-2619
(314) 291-3717
(314) 291-1671
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34210
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200701308
—
MO
01
—
6900
BCBS PROVIDER ID
MO
Enumeration date
09/26/2006
Last updated
01/19/2012
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