MEDICARE: MR. DUMRONG JIRASUT MD

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	208D00000X	General Practice Physician	A41741	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932214517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUMRONG JIRASUT MD

Provider Business Mailing Address
First Line	:	75 W MARCH LANE
Second Line	:	SUITE H
City	:	STOCKTON
State	:	CA
Zip	:	95207-5729
Country	:	US
Telephone Number	:	209-477-4485
Fax Number	:	209-477-4487

Provider Business Practice Location Address
First Line	:	75 W MARCH LANE
Second Line	:	SUITE H
City	:	STOCKTON
State	:	CA
Zip	:	95207-5729
Country	:	US
Telephone Number	:	209-477-4485
Fax Number	:	209-477-4487

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. DUMRONG JIRASUT MD” Practice Location

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