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General NPI Number Information
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NPI Number | 1982938791
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Entity Type | Individual
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Provider Name | PATRICK PIYA LERTDILOK M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 1515 HOLCOMBE BLVD UNIT 1476
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City | HOUSTON
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State | TX
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Zip | 77030-4000
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Country | US
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Telephone | 713-792-8182
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Fax |
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Provider Business Mailing Address
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Address Line | 5465 JOHN DREAPER DR
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City | HOUSTON
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State | TX
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Zip | 77056-4230
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Country | US
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Telephone | 512-589-6262
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10034055
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | P5834
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License Number State | TX
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