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General NPI Number Information
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NPI Number | 1760612659
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Entity Type | Individual
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Provider Name | WATCHARASARN RATTANANAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2009
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 201 S GIBSON RD APT 1208
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City | HENDERSON
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State | NV
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Zip | 89012-2660
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Country | US
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Telephone | 615-345-5400
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Fax | 888-468-6603
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Provider Business Mailing Address
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Address Line | 3 MARYLAND FARMS STE 200
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City | BRENTWOOD
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State | TN
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Zip | 37027-5005
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Country | US
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Telephone | 615-345-5400
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Fax | 888-468-6603
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD2019-0793
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 17053
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 17053
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License Number State | NV
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