Provider Demographics
NPI:1093783235
Name:AMORNMARN, RUMPA (MD)
Entity Type:Individual
Prefix:
First Name:RUMPA
Middle Name:
Last Name:AMORNMARN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RUMPA
Other - Middle Name:
Other - Last Name:SUTHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:737 WEST OAK STREET
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741
Mailing Address - Country:US
Mailing Address - Phone:407-933-2775
Mailing Address - Fax:407-933-8406
Practice Address - Street 1:737 WEST OAK STREET
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-933-2775
Practice Address - Fax:407-933-8406
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00438732085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067844900Medicaid
FL15806XMedicare ID - Type Unspecified
FL067844900Medicaid