Provider Demographics
NPI:1386134757
Name:SOOKPRASONG, GEMMA M (DO)
Entity type:Individual
Prefix:
First Name:GEMMA
Middle Name:M
Last Name:SOOKPRASONG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 UPTOWN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3537
Mailing Address - Country:US
Mailing Address - Phone:972-817-6300
Mailing Address - Fax:254-313-4531
Practice Address - Street 1:294 UPTOWN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3537
Practice Address - Country:US
Practice Address - Phone:972-817-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10063989207Q00000X
TXS3880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine