Provider Demographics
NPI:1144466111
Name:DEEPRASERTKUL, PEERAWUT
Entity type:Individual
Prefix:
First Name:PEERAWUT
Middle Name:
Last Name:DEEPRASERTKUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BUDINGER AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4123
Mailing Address - Country:US
Mailing Address - Phone:407-891-2940
Mailing Address - Fax:407-891-2941
Practice Address - Street 1:1330 BUDINGER AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4123
Practice Address - Country:US
Practice Address - Phone:407-891-2940
Practice Address - Fax:407-891-2941
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237179207R00000X
NDPT 14024207RC0000X
FLME167835207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine