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

Theodore Inthaphom

Individual provider Medical Physician Assistant · NPI 1689202475

Theodore Inthaphom is a Physician Assistant in Houston, Texas. Qualified in 2019, 7 years ago. Practices with UT Physicians, a 1,732-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
7
Licensed in
TX
In the registry since
2020
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Practice location Address checks out

6400 Fannin St Ste 1700
Houston, TX 77030-1526
Phone: (682) 554-4173
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA13459 (TX)

Record details

NPI number1689202475
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 29, 2020
Last updated in NPPESAugust 4, 2022
Certification dateAugust 4, 2022

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Ut Physicians — 1732 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations9 on file with Medicare

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