Healthcare Provider Details

I. General information

NPI: 1134562507
Provider Name (Legal Business Name): CHRISTOPHER PAUL SOERGEL IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MOBILE DIVING AND SALVAGE UNIT ONE BUILDING 17 BISHOP POINT
APO AE
96660-7005
US

IV. Provider business mailing address

MOBILE DIVING AND SALVAGE UNIT ONE BUILDING 17 BISHOP POINT
APO AE
96660-7005
US

V. Phone/Fax

Practice location:
  • Phone: 808-471-0755
  • Fax:
Mailing address:
  • Phone: 808-471-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: