Healthcare Provider Details

I. General information

NPI: 1083944409
Provider Name (Legal Business Name): JOSEPH ENDERTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3864 CHUM LN NW
BREMERTON WA
98312-9443
US

IV. Provider business mailing address

3864 CHUM LN NW
BREMERTON WA
98312-9443
US

V. Phone/Fax

Practice location:
  • Phone: 360-315-4204
  • Fax:
Mailing address:
  • Phone:
  • 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: