Healthcare Provider Details

I. General information

NPI: 1659515070
Provider Name (Legal Business Name): DAVID J BILLINGS IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353D OPERATIONS SUPPORT SQUADRON UNIT 5247 BOX 10
APO AP
96368
US

IV. Provider business mailing address

353D OPERATIONS SUPPORT SQUADRON UNIT 5247 BOX 10
APO AP
96368
US

V. Phone/Fax

Practice location:
  • Phone: 01181989615953
  • Fax:
Mailing address:
  • Phone: 01181989615953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: