Individual
DR. CHANINTHORN SETABUTR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
605 W GIBSON ST, JASPER, TX 75951-4909
(409) 384-3478
(409) 383-1056
Mailing address
605 W GIBSON ST, JASPER, TX 75951-4909
(409) 384-3478
(409) 383-1056
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G1273
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00NA48
BCBS IDENTIFIER NUMBER
TX
Enumeration date
08/19/2005
Last updated
07/09/2007
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