Provider Demographics
NPI:1578610036
Name:LOPANSRI, SOMSAK (MD)
Entity Type:Individual
Prefix:
First Name:SOMSAK
Middle Name:
Last Name:LOPANSRI
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:PO BOX 489
Mailing Address - Street 2:946 EAST REED
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851-0489
Mailing Address - Country:US
Mailing Address - Phone:573-359-1372
Mailing Address - Fax:
Practice Address - Street 1:946 EAST REED ST.
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:MO
Practice Address - Zip Code:63851-0489
Practice Address - Country:US
Practice Address - Phone:573-358-1372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35172282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC38096Medicare UPIN