Provider Demographics
NPI:1457706723
Name:ROJANASTHIEN, SIRIPONG (MD)
Entity Type:Individual
Prefix:
First Name:SIRIPONG
Middle Name:
Last Name:ROJANASTHIEN
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 1:1755 S GRAND BLVD
Mailing Address - Street 2:DEPARTMENT OF OPHTHALMOLOGY
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104
Mailing Address - Country:US
Mailing Address - Phone:314-256-3200
Mailing Address - Fax:
Practice Address - Street 1:1070 GREENWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5404
Practice Address - Country:US
Practice Address - Phone:407-333-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144797207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology