Provider Demographics
NPI:1134269657
Name:SUVUNRUNGSI, PRECHA (MD)
Entity type:Individual
Prefix:
First Name:PRECHA
Middle Name:
Last Name:SUVUNRUNGSI
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 1:2109 S CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4110
Mailing Address - Country:US
Mailing Address - Phone:254-526-6604
Mailing Address - Fax:254-526-9606
Practice Address - Street 1:2109 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4110
Practice Address - Country:US
Practice Address - Phone:254-526-6604
Practice Address - Fax:254-526-9606
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110432502Medicaid
TX110432502Medicaid
TX00N139Medicare ID - Type Unspecified
TX110432502Medicaid