Healthcare Provider Details

I. General information

NPI: 1699732271
Provider Name (Legal Business Name): NAPAPORN JESSADAPAGORN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 W IH 10 STUITE 200
FORT STOCKTON TX
79735-2700
US

IV. Provider business mailing address

PO BOX 1060
FORT STOCKTON TX
79735-1060
US

V. Phone/Fax

Practice location:
  • Phone: 432-336-8511
  • Fax: 432-336-8511
Mailing address:
  • Phone: 432-336-8511
  • Fax: 432-336-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF1072
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: