Provider Demographics
NPI:1447332978
Name:LUANGJAMEKORN, VERACHAI (MD)
Entity type:Individual
Prefix:DR
First Name:VERACHAI
Middle Name:
Last Name:LUANGJAMEKORN
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 1:907 E REED ST
Mailing Address - Street 2:
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-1242
Mailing Address - Country:US
Mailing Address - Phone:573-359-3660
Mailing Address - Fax:573-359-3521
Practice Address - Street 1:907 E REED ST
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-1242
Practice Address - Country:US
Practice Address - Phone:573-359-3660
Practice Address - Fax:573-359-3521
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9873207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201064102Medicaid
MO201064102Medicaid
MOA25886Medicare UPIN