Provider Demographics
NPI:1922053560
Name:NIMITYONGSKUL, PRASIT (MD)
Entity Type:Individual
Prefix:
First Name:PRASIT
Middle Name:
Last Name:NIMITYONGSKUL
Suffix:
Gender:M
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-665-8200
Mailing Address - Fax:251-665-8210
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:STE 3N
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1512
Practice Address - Country:US
Practice Address - Phone:251-665-8200
Practice Address - Fax:251-665-8210
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11167207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51012200OtherBLUE CROSS
AL51501715OtherBLUE CROSS
MS00011214Medicaid
LA1464945Medicaid
AL000012200Medicaid
AL09-10435OtherUNITED HEALTH CARE
FL255674000Medicaid
MS00011214Medicaid
C75459Medicare UPIN
FL255674000Medicaid