Individual
SPENCER COREY SOUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
480 CENTRAL AVE, JBPHH, HI 96860-4908
(808) 869-2600
Mailing address
SEAL TEAM 2, UNIT 60003, FPO, AE 09501-4633
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Enumeration date
09/20/2012
Last updated
04/03/2025
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