Individual
MR. TORSAK VIMOKTAYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
1147 MAYPORT LANDING CIR, ATLANTIC BEACH, FL 32233-2296
(904) 372-4602
Mailing address
1147 MAYPORT LANDING CIR, ATLANTIC BEACH, FL 32233-2296
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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