Provider Demographics
NPI:1730131871
Name:KANTIPONG, VARA (MD)
Entity type:Individual
Prefix:DR
First Name:VARA
Middle Name:
Last Name:KANTIPONG
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 1:3105 W 15TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7700
Mailing Address - Country:US
Mailing Address - Phone:972-867-7915
Mailing Address - Fax:972-964-0237
Practice Address - Street 1:3105 W 15TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7700
Practice Address - Country:US
Practice Address - Phone:972-867-7915
Practice Address - Fax:972-964-0237
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6820207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology