Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Thanapoom Boonipat

Individual provider Plastic Surgery Physician · NPI 1154852705

Mr. Thanapoom Boonipat is a Plastic and Reconstructive Surgery in Fort Worth, Texas. Qualified in 2017, 9 years ago. Works from 3 locations and accepts Medicare assignment. Licensed in Minnesota and Texas.

Years since qualifying
9
Licensed in
MN, TX
In the registry since
2017
Specialties on file
3
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Practice location Address checks out

1500 S Main St
Fort Worth, TX 76104-4917
Phone: (817) 702-1100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 12505 Quaker Ave Ste A, Lubbock, TX 79424-7743 — (603) 731-6888
  • 525 Oak Centre Dr Ste 260, San Antonio, TX 78258-3945 — (603) 731-6888

Specialties & licences

Plastic Surgery Physician (primary) Taxonomy 208200000X · Licence U9214 (TX)
Plastic Surgery Physician Taxonomy 208200000X · Licence 28451 (MN)
Plastic Surgery Physician Taxonomy 208200000X · Licence 64276 (MN)

Record details

NPI number1154852705
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 24, 2017
Last updated in NPPESDecember 20, 2024
Certification dateDecember 20, 2024
Mailing addressPo Box 732973, Dallas, TX 75373-2973

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPLASTIC AND RECONSTRUCTIVE SURGERY
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Fort Worth