MEDICARE: DR. PENNY PRAPINPORN CLAY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M1378	TX
2	207P00000X	Emergency Medicine Physician	M1378	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0039BV	OTHER		GROUP PTAN
2	8K6571	OTHER	TX	INDIVIDUAL PTAN

General Provider Information

NPI Number	:	1598763617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENNY PRAPINPORN CLAY D.O.

Provider Business Mailing Address
First Line	:	815 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-3025
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 N VIRGINIA ST
Second Line	:
City	:	PORT LAVACA
State	:	TX
Zip	:	77979-3025
Country	:	US
Telephone Number	:	361-552-0266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/12/2016

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Directions to “ DR. PENNY PRAPINPORN CLAY D.O.” Practice Location

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