Provider Demographics
NPI:1366608630
Name:VIPRAKASIT, DAVIS P
Entity type:Individual
Prefix:
First Name:DAVIS
Middle Name:P
Last Name:VIPRAKASIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF NORTH CAROLINA CHAPEL HL
Mailing Address - Street 2:2114 PHYSICIAN'S OFFICE BUILDING, CAMPUS BOX 7235
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-0001
Mailing Address - Country:US
Mailing Address - Phone:919-966-2571
Mailing Address - Fax:919-966-0098
Practice Address - Street 1:UNIVERSITY OF NORTH CAROLINA CHAPEL HL
Practice Address - Street 2:2114 PHYSICIAN'S OFFICE BUILDING, CAMPUS BOX 7235
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-966-2571
Practice Address - Fax:919-966-0098
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44906208800000X
IL036116617208800000X
NC201100924208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44906OtherTN LICENSE
IL036116617OtherILLINOIS LICENSE
NC201100924OtherLICENSE