Healthcare Provider Details

I. General information

NPI: 1760691547
Provider Name (Legal Business Name): DONALD PAUL HIGHLEY JR. INDEPENDENT DUTY COR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS JAMES E, WILLIAMS (DDG 95)
NORFOLK VA
09575-1204
US

IV. Provider business mailing address

3929 TWO OAKS RD
PORTSMOUTH VA
23703-2647
US

V. Phone/Fax

Practice location:
  • Phone: 757-444-2344
  • Fax:
Mailing address:
  • Phone: 757-638-9426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: