Individual
MICKEY PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
UNIVERSITY AVE, OXFORD, MS 38655
(601) 910-8551
Mailing address
510 HOLLYBERRY DR, CLINTON, MS 39056-5524
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/14/2022
Last updated
01/14/2022
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