Healthcare Provider Details

I. General information

NPI: 1922039247
Provider Name (Legal Business Name): RONALD LEE HAMPTON IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 SEALION RD
SILVERDALE WA
98315-7102
US

IV. Provider business mailing address

7111 SEALION RD
SILVERDALE WA
98315-7102
US

V. Phone/Fax

Practice location:
  • Phone: 360-315-4166
  • Fax: 360-315-4101
Mailing address:
  • Phone: 360-315-4166
  • Fax: 360-315-4101

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: