Provider Demographics
NPI:1588419188
Name:BOONIPAT CRANIOFACIAL AND FACIAL PLASTIC SURGERY
Entity type:Organization
Organization Name:BOONIPAT CRANIOFACIAL AND FACIAL PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:THANAPOOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONIPAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-731-6888
Mailing Address - Street 1:3813 22ND ST STE E
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1156
Mailing Address - Country:US
Mailing Address - Phone:603-731-6888
Mailing Address - Fax:
Practice Address - Street 1:3813 22ND ST STE E
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1156
Practice Address - Country:US
Practice Address - Phone:603-731-6888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty