Healthcare Provider Details

I. General information

NPI: 1750510327
Provider Name (Legal Business Name): NATHANIEL SOUTAR RIAL MD/PHD/MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2009
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL 100 BREWSTER BLVD
APO AA
28547-2538
US

IV. Provider business mailing address

100 BREWSTER BLVD NAVAL HOSPITAL
CAMP LEJEUNE NC
28547-2538
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4159
  • Fax: 910-450-4194
Mailing address:
  • Phone: 910-450-4159
  • Fax: 910-450-4194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR71672
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: