Individual
DR. SOMKIAT SOPONTAMMARAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6401 INDIANA AVE, SUITE C, LUBBOCK, TX 79413-5740
(806) 799-3322
(806) 799-3327
Mailing address
4503 82ND PL, LUBBOCK, TX 79424-4239
(806) 441-1257
(325) 200-4498
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
N9304
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6702120
—
SD
01
—
TXB125279
TX MEDICARE INDIVIDUAL PTAN
TX
Enumeration date
07/15/2008
Last updated
03/20/2024
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