Individual
SURASAK PHUPHANICH
Active
Individual
SURASAK PHUPHANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
53514
GA
2084N0400X
Neurology Physician
53135
AZ
2084N0400X
Neurology Physician
Primary
A36229
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266604
—
AZ
Enumeration date
08/25/2006
Last updated
10/03/2019
Update your record
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