Healthcare Provider Details

I. General information

NPI: 1952399818
Provider Name (Legal Business Name): SUVIPA WIRI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FM 300
LEVELLAND TX
79336-6235
US

IV. Provider business mailing address

1000 FM 300
LEVELLAND TX
79336-6235
US

V. Phone/Fax

Practice location:
  • Phone: 806-894-7842
  • Fax: 806-894-3952
Mailing address:
  • Phone: 806-894-7842
  • Fax: 806-894-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG2058
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: