Provider Demographics
NPI:1174706360
Name:SERIBURI, VIMON
Entity type:Individual
Prefix:
First Name:VIMON
Middle Name:
Last Name:SERIBURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 W PARKER RD
Mailing Address - Street 2:#278-137
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7767
Mailing Address - Country:US
Mailing Address - Phone:917-519-3765
Mailing Address - Fax:915-207-2200
Practice Address - Street 1:3600 COMMUNICATIONS PKWY STE 675
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8162
Practice Address - Country:US
Practice Address - Phone:917-519-3765
Practice Address - Fax:915-207-2200
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4819207R00000X, 208M00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist