Healthcare Provider Details

I. General information

NPI: 1427559467
Provider Name (Legal Business Name): VERNON EUGENE SEARCY IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 100337 BOX 1
FPO AE
09570-3700
US

IV. Provider business mailing address

3127 SWEETWATER SPRINGS BLVD APT 98
SPRING VALLEY CA
91978-1532
US

V. Phone/Fax

Practice location:
  • Phone: 404-984-8638
  • 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: