Provider Demographics
NPI:1699732271
Name:JESSADAPAGORN, NAPAPORN (MD)
Entity type:Individual
Prefix:DR
First Name:NAPAPORN
Middle Name:
Last Name:JESSADAPAGORN
Suffix:
Gender:F
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 1060
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-1060
Mailing Address - Country:US
Mailing Address - Phone:432-336-8511
Mailing Address - Fax:432-336-8511
Practice Address - Street 1:387 W IH 10
Practice Address - Street 2:STUITE 200
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-2700
Practice Address - Country:US
Practice Address - Phone:432-336-8511
Practice Address - Fax:432-336-8511
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1072208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87882SOtherBCBS
TX87882SOtherBCBS
TXB23763Medicare UPIN