Healthcare Provider Details

I. General information

NPI: 1760623375
Provider Name (Legal Business Name): RAYMOND RICHARD PRICE IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2ND MEDICAL BATTALION PSC BOX 20126
FPO AA
28542
US

IV. Provider business mailing address

2D MED BN 2D MLG PSC BOX 20126
FPO AA
28542-0129
US

V. Phone/Fax

Practice location:
  • Phone: 910-451-5125
  • Fax:
Mailing address:
  • Phone: 910-451-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: