Individual
PATHOM THAVARADHARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 W 30TH AVE STE 102, PAMPA, TX 79065-2814
(806) 669-2900
(806) 669-2301
Mailing address
100 W 30TH AVE STE 102, PAMPA, TX 79065-2814
(806) 669-2900
(806) 669-2301
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
L8581
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167273501
—
TX
01
—
8M7360
BLUE CROSS/BLUE SHIELD
TX
01
—
P00209318
RAILROAD MEDICARE, PALMETTO GBA
—
Enumeration date
07/16/2006
Last updated
07/25/2008
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