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General NPI Number Information
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NPI Number | 1962694042
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Entity Type | Individual
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Provider Name | KENDALL J. VERMILION M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | DAVID GRANT MEDICAL CENTER 101 BODIN CIRCLE
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City | TRAVIS AFB
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State | CA
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Zip | 94535
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Country | US
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Telephone | 707-423-5433
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Fax | 707-423-5426
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Provider Business Mailing Address
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Address Line | DAVID GRANT MEDICAL CENTER 101 BODIN CIRCLE
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City | TRAVIS AFB
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State | CA
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Zip | 94535
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Country | US
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Telephone | 707-423-5433
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Fax | 707-423-5426
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 0101245478
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License Number State | VA
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