Individual
WEERAWAT TANANUSONT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
133 ROUTE 3, DEDEDO, GU 96929-6911
(671) 645-5500
Mailing address
133 ROUTE 3, DEDEDO, GU 96929-6911
(671) 645-5500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11942
ND
207R00000X
Internal Medicine Physician
M-2047
GU
208M00000X
Hospitalist Physician
Primary
M-2047
GU
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16101
—
ND
Enumeration date
01/22/2009
Last updated
07/21/2022
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