MEDICARE: SCOTT G PITTMAN 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	:	1710151170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT G PITTMAN IDC

Provider Business Mailing Address
First Line	:	USS ANTIETAM
Second Line	:	CG 54
City	:	FPO
State	:	AP
Zip	:	96660-1174
Country	:	US
Telephone Number	:	619-556-4664
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS ANTIETAM
Second Line	:	CG 54
City	:	FPO
State	:	AP
Zip	:	96660-1174
Country	:	US
Telephone Number	:	619-556-4664
Fax Number	:

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

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/20/2008

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