MEDICARE: MR. JARED LYNN ALEXANDER IDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman		CA

General Provider Information

NPI Number	:	1083965461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JARED LYNN ALEXANDER IDC

Provider Business Mailing Address
First Line	:	1936 THIBODO RD APT 207
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92081-7944
Country	:	US
Telephone Number	:	406-529-1124
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS LPD 9 DENVER
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96663-1712
Country	:	US
Telephone Number	:	01181956501210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	09/26/2012

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