Organization
CHOTCHAI BOONKHAM MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHOTCHAI BOONKHAM MD (OWNER)
(314) 291-3717
Entity
Organization
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
261QP2300X
Primary Care Clinic/Center
Primary
34210
MO
Other
Enumeration date
01/19/2012
Last updated
01/19/2012
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