Healthcare Provider Details

I. General information

NPI: 1124261789
Provider Name (Legal Business Name): US NAVAL HOSPITAL GUANTANAMO BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USNH GTMO BOX 172
FPO AE
09589-1000
US

IV. Provider business mailing address

USNH GUANTANAMO BAY PRIMARY CARE BOX 172 FPO AE
FPO AE
09589-1000
US

V. Phone/Fax

Practice location:
  • Phone: 011539972944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number35078849
License Number StateOH

VIII. Authorized Official

Name: DR. TROY BOREMA
Title or Position: DIRECTOR OF MEDICAL SERVICES
Credential: M.D
Phone: 011599972944