Healthcare Provider Details

I. General information

NPI: 1588377022
Provider Name (Legal Business Name): MR. AARON PHOEBE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 12/29/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D MARINE RAIDER BATTALION
APO AA
28542-0073
US

IV. Provider business mailing address

PSC BOX 20073
APO AA
28542-0073
US

V. Phone/Fax

Practice location:
  • Phone: 774-573-3976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: