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General NPI Number Information
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NPI Number | 1659956308
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Entity Type | Organization
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Legal Business Name | THEERAPOL PRASERTSUNTARASAI MD PA
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 02/02/2022
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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 | 79424-6985
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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 STREET
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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 | MD/OWNER
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Name | DR. THEERAPOL PRASERTSUNTARASAI
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Credential | MD
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Telephone | 806-589-1778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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