Healthcare Provider Details

I. General information

NPI: 1649556515
Provider Name (Legal Business Name): MORRIS DAVID RINEHART II IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D RECON BN UNIT 36180
FPO AP
96602-6180
US

IV. Provider business mailing address

3D RECON BN UNIT 36180
FPO AP
96602-6180
US

V. Phone/Fax

Practice location:
  • Phone: 315-625-2480
  • Fax:
Mailing address:
  • Phone: 315-625-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number05103602MR
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: