Healthcare Provider Details

I. General information

NPI: 1427328319
Provider Name (Legal Business Name): UNITED STATES NAVY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 KNIGHT LN. BLDG H NAVY MEDICINE SUPPORT COMMAND,
JACKSONVILLE FL
32212-0140
US

IV. Provider business mailing address

2005 KNIGHT LN. BLDG H NAVY MEDICINE SUPPORT COMMAND,
JACKSONVILLE FL
32212-0140
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7200
  • Fax:
Mailing address:
  • Phone: 904-542-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number60781
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREW ROBERT STRICKLAND
Title or Position: DENTIST
Credential: DMD
Phone: 541-968-8845