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NPI Code Detail

MEDICARE: PIERCE OVERMAN PAC

MEDICARE:   PIERCE  OVERMAN  PAC
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
1207QA0000XAdolescent Medicine (Family Medicine) Physician100111NC

General Provider Information

NPI Number : 1588668982
Entity Type Code : Individual
Provider Name (Legal Business Name) : PIERCE OVERMAN PAC
Provider Business Mailing Address
First Line : 100 BREWSTER BLVD
Second Line : NAVAL HOSPITAL
City : CAMP LEJEUNE
State : NC
Zip : 28547-2538
Country : US
Telephone Number : 910-450-4136
Fax Number :
Provider Business Practice Location Address
First Line : 100 BREWSTER BLVD
Second Line : NAVAL HOSPITAL
City : CAMP LEJEUNE
State : NC
Zip : 28547-2538
Country : US
Telephone Number : 910-450-4136
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 11/16/2009

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