Provider Demographics
NPI:1083615389
Name:SATITPUNWAYCHA, PON (MD)
Entity Type:Individual
Prefix:DR
First Name:PON
Middle Name:
Last Name:SATITPUNWAYCHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11301 FALLBROOK DR
Mailing Address - Street 2:STE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4237
Mailing Address - Country:US
Mailing Address - Phone:281-890-9146
Mailing Address - Fax:281-894-1115
Practice Address - Street 1:11301 FALLBROOK DR
Practice Address - Street 2:STE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4237
Practice Address - Country:US
Practice Address - Phone:281-890-9146
Practice Address - Fax:281-894-1115
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2902208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E07986Medicare UPIN
TX00HZ84Medicare ID - Type Unspecified