Healthcare Provider Details

I. General information

NPI: 1760675573
Provider Name (Legal Business Name): JOHN A. FLEMING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON H-100, SANTA MARGARITA ROAD
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

6123 STEPHANIE DR
PANAMA CITY FL
32404-8858
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-8882
  • Fax:
Mailing address:
  • Phone: 760-725-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number652877
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: