=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013969989
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY DAVID WEEKS U.S. NAVY IDC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PSC 482 BOX 233
-----------------------------------------------------
City | FPO AP
-----------------------------------------------------
State | 96602
-----------------------------------------------------
Zip | 6602
-----------------------------------------------------
Country | JP
-----------------------------------------------------
Telephone | 936-632-0618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 506 WILLOW BEND DR
-----------------------------------------------------
City | LUFKIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75901-4840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-632-0618
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1710I1002X
-----------------------------------------------------
Taxonomy Name | Independent Duty Corpsman
-----------------------------------------------------
License Number | 1710I1002X
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------