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General NPI Number Information
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NPI Number | 1477769917
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Entity Type | Individual
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Provider Name | RANDY FERRER SWANSON SUBMARINE IDC
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | USS CHARLOTTE (SSN 766)
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City | FPO
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State | AP
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Zip | 96662-2422
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Country | US
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Telephone | 808-284-5484
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Fax |
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Provider Business Mailing Address
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Address Line | 91-328 HOOMALULE PLACE
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City | EWA BEACH
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State | HI
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Zip | 96706
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Country | US
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Telephone | 904-710-3267
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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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