Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Sipong Patamasucon

Individual provider Physician Assistant · NPI 1316747256

Sipong Patamasucon is a Physician Assistant in Lake Havasu City, Arizona. Qualified in 2024, 2 years ago. Practices with Thomas Dermatology, a 33-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
2
Licensed in
AZ
In the registry since
2025
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Practice location Address checks out

1801 Mesquite Ave
Lake Havasu City, AZ 86403-5668
Phone: (928) 854-5400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 2350 Miracle Mile, Bullhead City, AZ 86442-7505 — (928) 758-9362
  • 1815 N Stockton Hill Rd, Kingman, AZ 86401-4667 — (928) 753-9629

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 11017 (AZ)

Record details

NPI number1316747256
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 18, 2025
Last updated in NPPESMarch 18, 2025
Certification dateMarch 18, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Thomas Dermatology — 33 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Lake Havasu City