Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | S2393 | TX |
NPI | 1003221847 |
---|---|
Provider Name | Weerapong Lilitwat |
First Address | Lubbock, TX 79407-3545 |
Second Address | Lubbock, TX 79415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2014 |
Last Update Date | 07/04/2021 |