Provider Demographics
NPI:1669439162
Name:THAMMASITHIBOON, PRASERT (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASERT
Middle Name:
Last Name:THAMMASITHIBOON
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 1:387 W I H 10
Mailing Address - Street 2:PO BOX 1060
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-2700
Mailing Address - Country:US
Mailing Address - Phone:432-336-2067
Mailing Address - Fax:432-336-4511
Practice Address - Street 1:387 W I H 10
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-2700
Practice Address - Country:US
Practice Address - Phone:432-336-2067
Practice Address - Fax:432-336-4511
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1271208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87881SOtherBCBS
TX8G1464Medicare ID - Type Unspecified
TX87881SOtherBCBS