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General NPI Number Information
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NPI Number | 1235181058
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Entity Type | Individual
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Provider Name | DANIEL WILLIAM FEEBACK IDC
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 667 JOHN PAUL JONES CIR NAVAL MEDICAL CENTER PORTSMOUTH MEDICAL DEPARTMENT(CODE NO2M)
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City | NORFOLK
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State | VA
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Zip | 23511-2419
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Country | US
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Telephone | 757-443-0026
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Fax | 757-443-5706
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Provider Business Mailing Address
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Address Line | 4121 SHORELINE CIR APT 118
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-2165
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Country | US
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Telephone | 757-469-9642
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Fax |
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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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