Healthcare Provider Details

I. General information

NPI: 1497168629
Provider Name (Legal Business Name): JOSEPH THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US NAVAL HOSPITAL OKINAWA CAMP FOSTER PSC 482
APO AP
96362-1600
US

IV. Provider business mailing address

US NAVAL HOSPITAL OKINAWA PSC 482
FPO AP
96362-1600
US

V. Phone/Fax

Practice location:
  • Phone: 315-645-6114
  • 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: