Healthcare Provider Details

I. General information

NPI: 1225344401
Provider Name (Legal Business Name): RAMONE DALANE RESOP SFIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCM CREW FEARLESS
FPO AP
92101
US

IV. Provider business mailing address

10234 CREST RIDGE DR
PENSACOLA FL
32514-2617
US

V. Phone/Fax

Practice location:
  • Phone: 850-384-7849
  • Fax:
Mailing address:
  • Phone: 850-384-7849
  • 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: