Healthcare Provider Details

I. General information

NPI: 1619382645
Provider Name (Legal Business Name): DUSIT ADSTAMONGKONKUL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2014
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 E RIVER RD
TUCSON AZ
85718-6522
US

IV. Provider business mailing address

2450 E RIVER RD
TUCSON AZ
85718-6522
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-7750
  • Fax: 520-320-2155
Mailing address:
  • Phone: 520-795-7750
  • Fax: 520-320-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number7231
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2017039503
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number81086
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: