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General NPI Number Information
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NPI Number | 1265567242
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Entity Type | Individual
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Provider Name | PORNCHAI JONGLERTHAM MD
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 815 N KANSAS AVE
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City | HASTINGS
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State | NE
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Zip | 68901-4470
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Country | US
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Telephone | 402-460-5899
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Fax | 402-460-5898
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Provider Business Mailing Address
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Address Line | 815 N KANSAS AVE
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City | HASTINGS
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State | NE
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Zip | 68901-4470
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Country | US
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Telephone | 402-460-5899
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Fax | 402-460-5898
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 15910
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | N0144
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 24180
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License Number State | NE
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