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General NPI Number Information
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NPI Number | 1750141842
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Entity Type | Individual
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Provider Name | JAMES CLIFTON DENNIS IDMT
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Gender | Male
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | LACKLAND AFB TEXAS
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City | APO
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State | AA
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Zip | 78234
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Country | US
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Telephone | 507-412-9838
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Fax |
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Provider Business Mailing Address
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Address Line | 7914 RAY BON DR APT 1514
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City | SAN ANTONIO
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State | TX
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Zip | 78218-2154
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Country | US
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Telephone | 507-412-9838
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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 | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State |
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