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Individual

DR. PENNY PRAPINPORN CLAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025
(361) 552-0266
Mailing address
815 N VIRGINIA ST, PORT LAVACA, TX 77979-3025

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M1378
TX
207Q00000X
Family Medicine Physician
M1378
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0039BV
GROUP PTAN
01
8K6571
INDIVIDUAL PTAN
TX
Enumeration date
07/12/2005
Last updated
07/12/2016
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