Basic Information
| Provider Information | |||||||||
| NPI: | 1366608630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIPRAKASIT | ||||||||
| FirstName: | DAVIS | ||||||||
| MiddleName: | P | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF NORTH CAROLINA CHAPEL HL | ||||||||
| Address2: | 2114 PHYSICIAN'S OFFICE BUILDING, CAMPUS BOX 7235 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199662571 | ||||||||
| FaxNumber: | 9199660098 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF NORTH CAROLINA CHAPEL HL | ||||||||
| Address2: | 2114 PHYSICIAN'S OFFICE BUILDING, CAMPUS BOX 7235 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199662571 | ||||||||
| FaxNumber: | 9199660098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2008 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 44906 | TN | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 036116617 | IL | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 201100924 | NC | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 44906 | 01 | TN | TN LICENSE | OTHER | 036116617 | 01 | IL | ILLINOIS LICENSE | OTHER | 201100924 | 01 | NC | LICENSE | OTHER |