Provider Demographics
NPI:1306976733
Name:SRISINROONGRUANG, RATTAPOL (MD)
Entity type:Individual
Prefix:
First Name:RATTAPOL
Middle Name:
Last Name:SRISINROONGRUANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960160
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0160
Mailing Address - Country:US
Mailing Address - Phone:888-447-2450
Mailing Address - Fax:
Practice Address - Street 1:800 W RANDOL MILL RD
Practice Address - Street 2:DEPT OF EMERGENCY MEDICINE
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:817-548-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-02-03
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-05-02
Provider Licenses
StateLicense IDTaxonomies
DEC70003449207P00000X
TXN4124207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00778778OtherRAILROAD MCARE THRU AEMA
TX204229301Medicaid
TX8BT332OtherBCBS TX
TX204229302Medicaid
TX8BT332OtherBCBS TX
TX8L17501Medicare PIN