MEDICARE: MR. JUSTIN BRIAN HESS IDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman		CA

General Provider Information

NPI Number	:	1154766673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN BRIAN HESS IDC

Provider Business Mailing Address
First Line	:	1870 GATOR BLVD
Second Line	:	BUILDING 3842
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23459-8900
Country	:	US
Telephone Number	:	757-763-2560
Fax Number	:

Provider Business Practice Location Address
First Line	:	1870 GATOR BLVD
Second Line	:	BUILDING 3842
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23459-8900
Country	:	US
Telephone Number	:	757-763-2560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	05/10/2013

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