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Individual

DR. RANGSAN SUVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2500 LUCY LEE PARKWAY, POPLAR BLUFF, MO 63901
(573) 686-2585
(573) 686-4415
Mailing address
2500 LUCY LEE PARKWAY, POPLAR BLUFF, MO 63901
(573) 686-2585
(573) 686-4415

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
R5641
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
108033001
ARKANSAS INDIVIDUAL MEDICAID NUMBER
AR
05
200331510
MO
Enumeration date
02/03/2006
Last updated
06/23/2008
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