Provider Demographics
NPI:1043388481
Name:CHULAMORKODT, NATAKOM NASH (MD)
Entity type:Individual
Prefix:DR
First Name:NATAKOM
Middle Name:NASH
Last Name:CHULAMORKODT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 6514
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2522
Mailing Address - Country:US
Mailing Address - Phone:928-257-8699
Mailing Address - Fax:928-341-1973
Practice Address - Street 1:2275 S ELKS LN
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6258
Practice Address - Country:US
Practice Address - Phone:928-257-8699
Practice Address - Fax:928-341-1973
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2020-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL336078174208800000X
AZ37017208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology