Provider Demographics
NPI:1194038067
Name:TRAIRATVORAKUL, PON (MD)
Entity Type:Individual
Prefix:DR
First Name:PON
Middle Name:
Last Name:TRAIRATVORAKUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 CENTER ST
Mailing Address - Street 2:PEDIATRIC RESIDENCY PROGRAM
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-3301
Mailing Address - Country:US
Mailing Address - Phone:251-415-1087
Mailing Address - Fax:251-415-1087
Practice Address - Street 1:1504 SPRINGHILL AVE
Practice Address - Street 2:CHILDREN'S MEDICAL CENTER
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3207
Practice Address - Country:US
Practice Address - Phone:251-434-3915
Practice Address - Fax:251-434-3802
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program