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General NPI Number Information
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NPI Number | 1568469062
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Entity Type | Organization
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Legal Business Name | JIRAYOS CHINTANADILOK
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 4296 5TH AVE
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City | MARIANNA
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State | FL
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Zip | 32446-2173
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Country | US
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Telephone | 850-482-2061
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Fax | 850-482-6617
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Provider Business Mailing Address
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Address Line | 4296 5TH AVE
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City | MARIANNA
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State | FL
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Zip | 32446-2173
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Country | US
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Telephone | 850-482-2061
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Fax | 850-482-6617
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Authorized Official
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Title or Position | M.D. (OWNER)
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Name | JIRAYOS CHINTANADILOK
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Credential | M.D.
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Telephone | 850-482-2061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | ARNP
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9101074
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME77246
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME77246
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME77246
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | ARNP1903302
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME27861
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License Number State | FL
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