Provider Demographics
NPI:1053399584
Name:PAPPAS, PUIFUN LILA (MD)
Entity type:Individual
Prefix:DR
First Name:PUIFUN
Middle Name:LILA
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PUIFUN
Other - Middle Name:LILA
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2800 S TEXAS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5361
Mailing Address - Country:US
Mailing Address - Phone:979-690-4808
Mailing Address - Fax:979-690-4809
Practice Address - Street 1:2410 BOONVILLE RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-2226
Practice Address - Country:US
Practice Address - Phone:979-690-4808
Practice Address - Fax:979-690-4809
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD44774207Q00000X
MS25502207Q00000X
MN63057207Q00000X
ARE-1886207Q00000X
IL036144402207Q00000X
TXL0485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M5290OtherBLUE CROSS BLUE SHIELD
TX1053399584Medicaid
AR135872001Medicaid
AR5K927OtherBLUE CROSS BLUE SHIELD
TXQ00556599OtherRAILROAD MEDICARE
TX0421539003Medicaid
TXP00190616OtherRAILROAD MEDICARE