Individual
MR. DAVEN MARCEL PANTOHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3726 BROADWAY STE 201, EVERETT, WA 98201-3788
(425) 317-9119
(425) 317-9118
Mailing address
3726 BROADWAY STE 201, EVERETT, WA 98201-3788
(425) 317-9119
(425) 317-9118
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
60611622
WA
363AS0400X
Surgical Physician Assistant
PA60611622
WA
Other
Enumeration date
09/20/2014
Last updated
08/23/2021
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