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General NPI Number Information
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NPI Number | 1295024461
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Entity Type | Organization
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Legal Business Name | UNITED STATES AIR FORCE
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 101 BODIN CIR
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City | FAIRFIELD
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State | CA
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Zip | 94535-1809
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Country | US
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Telephone | 707-423-7231
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Fax |
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Provider Business Mailing Address
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Address Line | 101 BODIN CIR
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City | FAIRFIELD
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State | CA
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Zip | 94535-1809
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Country | US
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Telephone | 707-423-7231
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Fax |
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Authorized Official
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Title or Position | RADIOLOGY RESIDENT
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Name | DR. DENNIS DEAN WALKER
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Credential | D.O
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Telephone | 707-234-7231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 0102201806
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License Number State | VA
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