Organization
PATHOM THAVARADHARA MD PA
Active
Organization
PATHOM THAVARADHARA MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATHOM THAVARADHARA MD (PRESIDENT)
(806) 669-2900
Entity
Organization
Contact information
Practice address
100 W 30TH AVE STE 102, PAMPA, TX 79065-2814
(806) 669-2900
(806) 669-2031
Mailing address
100 W 30TH AVE STE 102, PAMPA, TX 79065-2814
(806) 669-2900
(806) 669-2031
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
L8581
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0012LM
BLUE CROSS/BLUE SHIELD
TX
05
—
167272701
—
TX
01
—
DD1161
RAILROAD MEDICARE, PALMETTO GBA
TX
Enumeration date
03/24/2008
Last updated
07/25/2008
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