Provider Demographics
NPI:1063421303
Name:THAMPOE, BASTI J (MD)
Entity type:Individual
Prefix:
First Name:BASTI
Middle Name:J
Last Name:THAMPOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 S FRY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2252
Mailing Address - Country:US
Mailing Address - Phone:281-500-8176
Mailing Address - Fax:281-500-8178
Practice Address - Street 1:7322 SOUTHWEST FWY
Practice Address - Street 2:SUITE 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2010
Practice Address - Country:US
Practice Address - Phone:713-532-6884
Practice Address - Fax:713-532-5756
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM0288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171156602Medicaid
TX8J2363Medicare PIN
TX171156602Medicaid