Individual
BOONTHARICK SOPONTAMMARAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3551 ROGER BROOKE DR, JBSA FT SAM HOUSTON, TX 78234-4504
(210) 292-7805
(210) 292-7868
Mailing address
3551 ROGER BROOKE DR, JBSA FT SAM HOUSTON, TX 78234-4504
(210) 292-7805
(210) 292-7868
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
208D00000X
General Practice Physician
Primary
0102208949
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/24/2023
Last updated
11/23/2024
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