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General NPI Number Information
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NPI Number | 1841482577
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Entity Type | Organization
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Legal Business Name | YUMA UROLOGY CENTER PLLC
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 2275 S ELKS LN
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City | YUMA
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State | AZ
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Zip | 85364-6258
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Country | US
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Telephone | 928-341-1900
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Fax | 928-341-1973
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Provider Business Mailing Address
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Address Line | PO BOX 6514
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City | YUMA
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State | AZ
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Zip | 85366-2522
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Country | US
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Telephone | 928-257-8699
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Fax | 928-341-1973
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATAKOM NASH CHULAMORKODT
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Credential | M.D.
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Telephone | 773-501-7706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 37017
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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