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General NPI Number Information
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NPI Number | 1538394564
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Entity Type | Organization
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Legal Business Name | USAF
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | PSC 103 BOX 2882
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City | APO
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State | AE
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Zip | 09603-0029
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Country | US
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Telephone | 43-430-5101
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 103 BOX 2882
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City | APO
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State | AE
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Zip | 09603-0029
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | IDMT
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Name | ROBYN ROSEMARY PONOMAR-FORD
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Credential |
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Telephone | 43-430-5101
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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 | 987654321987654321
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License Number State | ZZ
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