Healthcare Provider Details

I. General information

NPI: 1396729067
Provider Name (Legal Business Name): RONALD T PURCELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USNH YOKOSUKA JAPAN PCS 475 BOX 1
FPO AP
96350
JP

IV. Provider business mailing address

USNH YOKOSUKA JAPAN PSC 475 BOX 1882
FPO AP
96350
JP

V. Phone/Fax

Practice location:
  • Phone: 11-814-6816
  • Fax:
Mailing address:
  • Phone: 11-814-6816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number28289
License Number StateAZ

VIII. Authorized Official

Name: DR. RONALD TODD PURCELL
Title or Position: STAFF PHYSICIAN
Credential: WD
Phone: 11-814-6816