Provider Demographics
NPI:1942376140
Name:TRISARNSRI, SOMJAI (MD)
Entity Type:Individual
Prefix:
First Name:SOMJAI
Middle Name:
Last Name:TRISARNSRI
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 1:117 MEDICAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482
Mailing Address - Country:US
Mailing Address - Phone:903-885-8471
Mailing Address - Fax:903-439-6492
Practice Address - Street 1:117 MEDICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482
Practice Address - Country:US
Practice Address - Phone:903-885-8471
Practice Address - Fax:903-439-6492
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7644207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11O542102Medicaid
TX00NK25Medicare PIN
E08643Medicare UPIN