Healthcare Provider Details

I. General information

NPI: 1073304788
Provider Name (Legal Business Name): VITCHAPONG PRASITSUMRIT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH STREET, TEXAS TECH UNIVERSITY HEALTH SCIENCES STOP 9410
LUBBOCK TX
79430
US

IV. Provider business mailing address

3601 4TH STREET, TEXAS TECH UNIVERSITY HEALTH SCIENCES STOP 9410
LUBBOCK TX
79430
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-2978
  • Fax:
Mailing address:
  • Phone: 806-743-2978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: