PHOKHAM MIKE SOURIVANH

PENSACOLA, FL
NPI1972022762
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
Additional Taxonomies171000000X Military Health Care Provider
Enumeration Date2017-09-13
Last Update Date2025-06-24
Business Address
Mr. PHOKHAM MIKE SOURIVANH PA-C
NMRTC PENSACOLA 6000 WEST HIGHWAY 98
PENSACOLA, FL 32512-0001
Phone number: 901-874-6081
Mailing Address
Mr. PHOKHAM MIKE SOURIVANH PA-C
CAMP PENDLETON
APO, AP 92055
Phone number:
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