Healthcare Provider Details

I. General information

NPI: 1467420471
Provider Name (Legal Business Name): BERNARD HARRIS JR. IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL GTMO
FPO AE
09589
US

IV. Provider business mailing address

USNH GTMO BOX 27
FPO AE
09589
US

V. Phone/Fax

Practice location:
  • Phone: 757-443-8100
  • Fax:
Mailing address:
  • Phone: 757-443-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: