MEDICARE: CHRISTOPHER RYAN LOVING

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	:	1558555094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER RYAN LOVING

Provider Business Mailing Address
First Line	:	321 BULLFINCH RD
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-7012
Country	:	US
Telephone Number	:	850-230-3275
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 BULLFINCH RD
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-7012
Country	:	US
Telephone Number	:	850-230-3275
Fax Number	:

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	02/26/2014

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