MEDICARE: DR. KRAIYUTH VONGXAIBURANA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	ME92316	FL
2	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	ME92316	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	1487660247	OTHER	FL	MD MEDICARE CHOICE
13	P00438736	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1065312	OTHER	FL	AETNA
2	1447267000	OTHER	FL	PHYSICIANS UNITED PLAN
3	15484901	OTHER	FL	CITRUS
4	593661648	OTHER	FL	UNIVERSAL HEALTH CARE
5	593661648	OTHER	FL	EVOLUTIONS
7	29630	OTHER	FL	COMP OPTIONS
8	304355	OTHER		AVMED
9	29630	OTHER	FL	BC BS FL
10	P05944	OTHER	FL	FREEDOM HEALTH
11	2615237	OTHER	FL	UNITED HEALTH CARE
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447267000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRAIYUTH VONGXAIBURANA M.D.

Provider Business Mailing Address
First Line	:	4881 NW 8TH AVE
Second Line	:	SUITE 2
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-4582
Country	:	US
Telephone Number	:	352-373-6338
Fax Number	:	352-373-6144

Provider Business Practice Location Address
First Line	:	4343 WEST NEWBERRY RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-2817
Country	:	US
Telephone Number	:	352-224-2200
Fax Number	:	352-224-2484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/30/2012

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