Provider Demographics
NPI:1407844350
Name:WIRI, WEERACHAI (MD)
Entity Type:Individual
Prefix:
First Name:WEERACHAI
Middle Name:
Last Name:WIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 JOHN DUPRE DR
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-6300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 JOHN DUPRE DR
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-6300
Practice Address - Country:US
Practice Address - Phone:806-894-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1804208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00RP09OtherBLUE CROSS BLUE SHIELD
4668718OtherAETNA
TXMDG1804OtherWORKERS COMP
TX121302OtherSUPERIOR HEALTH PLAN
TX00RP09OtherBLUE CROSS BLUE SHIELD
TX121302OtherSUPERIOR HEALTH PLAN