Individual
DR. TANUSIN PLOYSANGAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1010 4TH ST SW, STE 330, MASON CITY, IA 50401-2857
(641) 424-0402
Mailing address
PO BOX 1894, MASON CITY, IA 50402-1894
(641) 494-3041
(641) 494-3059
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
37142
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37142
IOWA LICENSE
IA
Enumeration date
03/29/2007
Last updated
05/12/2008
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