Healthcare Provider Details

I. General information

NPI: 1770718017
Provider Name (Legal Business Name): CHRISTOPHER JOHN HOAR IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 ARNOLD DR BLDG 1090/FLIGHT MEDICINE
LR AFB AR
72099-4933
US

IV. Provider business mailing address

1090 ARNOLD DR BLDG 1090/FLIGHT MEDICINE
LR AFB AR
72099-4933
US

V. Phone/Fax

Practice location:
  • Phone: 501-987-7319
  • Fax: 501-987-7349
Mailing address:
  • Phone: 501-987-7319
  • Fax: 501-987-7349

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: