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Individual
TANPRASERTH VATANADILOK
Active
Individual
TANPRASERTH VATANADILOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
611125
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170306808
WELLMED MEDICAID
TX
01
—
TXB158725
WELLMED MEDICARE
TX
Enumeration date
07/08/2006
Last updated
10/18/2016
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