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Boontharick Sopontammarak, DO
Military Health Care Provider in Jbsa Ft Sam Houston, Texas
NPI 1851090252

Boontharick Sopontammarak is a Military Health Care Provider based in Jbsa Ft Sam Houston, TX. Boontharick Sopontammarak practices in Jbsa Ft Sam Houston, TX and has the professional credentials of DO. The NPI Number for Boontharick Sopontammarak is 1851090252 and holds a License No. (Texas).

The current practice location address for Boontharick Sopontammarak is 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX and can be reached out via phone at 210-292-7805 and via fax at 210-292-7868.

Location: 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX, 78234-4504
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1851090252
Provider Name
Boontharick Sopontammarak
Credential
DO
Provider Entity Type
Individual
Gender
Female
Address
3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX, 78234-4504
Phone Number
210-292-7805
Fax Number
210-292-7868
Provider Enumeration Date
02/24/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
3551 Roger Brooke Dr
City
Jbsa Ft Sam Houston
State
Texas
Zip
78234-4504
Phone Number
210-292-7805
Fax Number
210-292-7868
person
Provider Business Mailing Address Details
Address
3551 Roger Brooke Dr
City
Jbsa Ft Sam Houston
State
Texas
Zip
78234-4504
Phone Number
210-292-7805
Fax Number
210-292-7868
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
171000000X
License No.
()
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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