Healthcare Provider Details

I. General information

NPI: 1023021748
Provider Name (Legal Business Name): DAVID WELDON HIMES HM1
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL UNDERSEA MEDICAL INSTITUTE BLDG 159
GROTON CT
06349-5159
US

IV. Provider business mailing address

33 HORNBEAM RD
GROTON CT
06340-3007
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-2876
  • Fax: 860-694-3874
Mailing address:
  • Phone: 808-551-6667
  • 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: