Provider Demographics
NPI:1447267000
Name:VONGXAIBURANA, KRAIYUTH (MD)
Entity type:Individual
Prefix:DR
First Name:KRAIYUTH
Middle Name:
Last Name:VONGXAIBURANA
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 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-373-6338
Mailing Address - Fax:352-373-6144
Practice Address - Street 1:4343 WEST NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2817
Practice Address - Country:US
Practice Address - Phone:352-224-2200
Practice Address - Fax:352-224-2484
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME923162084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1065312OtherAETNA
FL1447267000OtherPHYSICIANS UNITED PLAN
FL15484901OtherCITRUS
FL593661648OtherUNIVERSAL HEALTH CARE
FL593661648OtherEVOLUTIONS
FL1487660247OtherMD MEDICARE CHOICE
FL29630OtherCOMP OPTIONS
304355OtherAVMED
FL29630OtherBC BS FL
FLP05944OtherFREEDOM HEALTH
FL2615237OtherUNITED HEALTH CARE
FL273660800Medicaid
FLP00438736OtherMEDICARE RAILROAD
FL273660800Medicaid
FL29630ZMedicare PIN