Healthcare Provider Details

I. General information

NPI: 1962694042
Provider Name (Legal Business Name): KENDALL J. VERMILION M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DAVID GRANT MEDICAL CENTER 101 BODIN CIRCLE
TRAVIS AFB CA
94535
US

IV. Provider business mailing address

DAVID GRANT MEDICAL CENTER 101 BODIN CIRCLE
TRAVIS AFB CA
94535
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-5433
  • Fax: 707-423-5426
Mailing address:
  • Phone: 707-423-5433
  • Fax: 707-423-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101245478
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: