Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | MD28385 | OR |
N | 207RR0500X | Rheumatology | MD28385 | OR |
Y | 207RR0500X | Rheumatology | R1108 | TX |
NPI | 1245373380 |
---|---|
Provider Name | Theerapol Prasertsuntarasai |
First Address | Lubbock, TX 79424 |
Second Address | Lubbock, TX 79424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 31/08/2021 |