Healthcare Provider Details

I. General information

NPI: 1588879779
Provider Name (Legal Business Name): RALPH ALLEN ROWE JR. IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MOBILE SECURITY SQUADRON SIX NNSY BLD 15
PORTSMOUTH VA
23709-5000
US

IV. Provider business mailing address

209 ROBINHOOD RD
CHESAPEAKE VA
23322-7164
US

V. Phone/Fax

Practice location:
  • Phone: 757-967-4195
  • Fax: 757-967-4152
Mailing address:
  • Phone: 757-967-4195
  • Fax: 757-967-4152

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: