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General NPI Number Information
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NPI Number | 1093741993
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Entity Type | Individual
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Provider Name | ELISHA ALEXANDER IDC US NAVY
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1959 MORRIS ST SUITE 120 BLDG Z101
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City | NORFOLK
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State | VA
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Zip | 23511-3427
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Country | US
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Telephone | 757-443-0002
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Fax | 757-443-5607
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Provider Business Mailing Address
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Address Line | 1200 RENFREW ST
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-8915
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Country | US
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Telephone | 757-467-0561
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Fax | 757-443-5706
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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