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General NPI Number Information
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NPI Number | 1245373380
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Entity Type | Individual
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Provider Name | THEERAPOL PRASERTSUNTARASAI MD
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Gender | Male
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 5609 114TH ST
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City | LUBBOCK
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State | TX
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Zip | 79424
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Country | US
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Telephone | 806-589-1778
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Fax | 806-589-1779
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Provider Business Mailing Address
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Address Line | 5609 114TH ST
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City | LUBBOCK
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State | TX
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Zip | 79424
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Country | US
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Telephone | 806-589-1778
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Fax | 806-589-1779
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number | MD28385
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | MD28385
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | R1108
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License Number State | TX
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