Provider Demographics
NPI:1760612659
Name:RATTANANAN, WATCHARASARN (MD)
Entity Type:Individual
Prefix:DR
First Name:WATCHARASARN
Middle Name:
Last Name:RATTANANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3 MARYLAND FARMS STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5005
Mailing Address - Country:US
Mailing Address - Phone:615-345-5400
Mailing Address - Fax:888-468-6603
Practice Address - Street 1:201 S GIBSON RD APT 1208
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-2660
Practice Address - Country:US
Practice Address - Phone:615-345-5400
Practice Address - Fax:888-468-6603
Is Sole Proprietor?:No
Enumeration Date:2009-07-25
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2019-07932084N0400X
NV170532084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2019-0793OtherNEW MEXICO MEDICAL BOARD