Individual
JASON TYLER DUMRONGKULRAKSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 N BONITA AVE, PANAMA CITY, FL 32401-3623
(850) 747-6000
Mailing address
615 N BONITA AVE, PANAMA CITY, FL 32401-3623
(850) 747-6000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9106023
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9106023
FLORIDA BOARD OF MEDICINE
FL
Enumeration date
08/04/2011
Last updated
12/16/2011
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