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General NPI Number Information
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NPI Number | 1861664435
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Entity Type | Organization
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Legal Business Name | PATHOM THAVARADHARA MD PA
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 100 W 30TH AVE STE 102
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City | PAMPA
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State | TX
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Zip | 79065-2814
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Country | US
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Telephone | 806-669-2900
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Fax | 806-669-2031
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Provider Business Mailing Address
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Address Line | 100 W 30TH AVE STE 102
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City | PAMPA
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State | TX
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Zip | 79065-2814
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Country | US
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Telephone | 806-669-2900
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Fax | 806-669-2031
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATHOM THAVARADHARA
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Credential | MD
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Telephone | 806-669-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | L8581
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License Number State | TX
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