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General NPI Number Information
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NPI Number | 1902872039
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Entity Type | Organization
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Legal Business Name | US ARMY MEDCOM
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 900 ARMY NAVY DR SUITE 1533
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City | ARLINGTON
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State | VA
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Zip | 22202-4927
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Country | US
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Telephone | 703-418-3716
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Fax |
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Provider Business Mailing Address
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Address Line | 6225 25TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-4125
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Country | US
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Telephone | 727-347-1953
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Fax |
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Authorized Official
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Title or Position | STAFF OFFICER
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Name | MR. JAMES JOSEPH SHEAR
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Credential | PA
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Telephone | 703-693-5601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2261
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License Number State | FL
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