Healthcare Provider Details

I. General information

NPI: 1407928377
Provider Name (Legal Business Name): KEVIN SCOTT VARNER SFIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS JOHN S. MCCAIN DDG-56
FPO AP CA
96672-1274
US

IV. Provider business mailing address

USS JOHN S. MCCAIN DDG-56
FPO AP
96672
US

V. Phone/Fax

Practice location:
  • Phone: 314-241-9966
  • Fax:
Mailing address:
  • Phone: 314-241-9966
  • 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: