Healthcare Provider Details

I. General information

NPI: 1245347483
Provider Name (Legal Business Name): PAUL D. LAVIGNE EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAHC GRAF CMR 415
APO AE
09114
DE

IV. Provider business mailing address

CMR 415 BOX 3569
APO AE
09114
DE

V. Phone/Fax

Practice location:
  • Phone: 09641837152
  • Fax:
Mailing address:
  • Phone: 09641925870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberB1498591
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: