Individual
DR. VIENGSOUK PHOMMACHANH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 UNIVERSITY PKWY STE 102, SARASOTA, FL 34243-2894
(941) 355-2767
Mailing address
2401 UNIVERSITY PKWY STE 102, SARASOTA, FL 34243-2894
(941) 355-2767
(941) 355-0617
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME98812
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002451300
—
FL
01
—
DI326Z
PTAN
FL
Enumeration date
06/03/2007
Last updated
10/28/2021
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