Healthcare Provider Details

I. General information

NPI: 1265402424
Provider Name (Legal Business Name): THIDAPORN TANPATTANA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 06/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 W MILLER ST
ORLANDO FL
32806-2032
US

IV. Provider business mailing address

1500 CONCORD TER
SUNRISE FL
33323-2815
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-9111
  • Fax: 954-858-0404
Mailing address:
  • Phone: 800-243-3839
  • Fax: 954-858-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS8936
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS8936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: