Individual
ALEX OUDOMSACK SOPHABMIXAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
800 SPRUCE ST, PHILADELPHIA, PA 19107-6192
(570) 561-4024
Mailing address
800 SPRUCE ST, PHILADELPHIA, PA 19107-6192
(570) 561-4024
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/14/2026
Last updated
04/14/2026
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