Individual
THEODORE INTHAPHOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6400 FANNIN ST STE 1700, HOUSTON, TX 77030-1526
(682) 554-4173
Mailing address
6400 FANNIN ST STE 1700, HOUSTON, TX 77030-1526
(682) 554-4173
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA13459
TX
Other
Enumeration date
03/29/2020
Last updated
08/04/2022
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