MEDICARE: MR. GASPARE JOSEPH CORRAO 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	:	1609830298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GASPARE JOSEPH CORRAO IDC

Provider Business Mailing Address
First Line	:	91-1025 KAIHANUPA ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-5062
Country	:	US
Telephone Number	:	808-471-2098
Fax Number	:

Provider Business Practice Location Address
First Line	:	COMMANDING OFFICER
Second Line	:	ATTN: SENIOR MEDICAL DEPARTMENT REPRESENTATIVE
City	:	FPO
State	:	AP
Zip	:	96674
Country	:	US
Telephone Number	:	808-471-2098
Fax Number	:

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	04/20/2008

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