MEDICARE: MR. JOHN H HOLSCHER 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

General Provider Information

NPI Number	:	1518239565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN H HOLSCHER IDC

Provider Business Mailing Address
First Line	:	3392 DALEY CENTER DR
Second Line	:	APT 204
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4603
Country	:	US
Telephone Number	:	301-802-6301
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS SENTRY
Second Line	:	MCM 3
City	:	FPO
State	:	AP
Zip	:	96660-1923
Country	:	US
Telephone Number	:	301-802-6301
Fax Number	:

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

Provider Enumeration Date	:	02/07/2012
Last Update Date	:	02/07/2012

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