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General NPI Number Information
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NPI Number | 1801091285
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Entity Type | Individual
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Provider Name | RICHARD JUSTIN ENGLE NAVY IDC
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Gender | Male
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2ND BATTALION 9TH MARINES BLDG. 514 2ND MARINE DIVISION
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City | CAMP LEJEUNE
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State | NC
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Zip | 28542
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Country | US
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Telephone | 910-450-9431
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Fax |
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Provider Business Mailing Address
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Address Line | 606 PLAZA DR
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5128
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Country | US
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Telephone | 678-656-8999
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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 | 1710I1002X
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License Number State | NC
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