MEDICARE: MR. JOHN WESLEY HUCKLEBERRY II HMC

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	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1528210374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN WESLEY HUCKLEBERRY II HMC

Provider Business Mailing Address
First Line	:	PO BOX 15274
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23511-0274
Country	:	US
Telephone Number	:	614-657-5188
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIT 100236 DRAWER 2703
Second Line	:	USS DWIGHT D EISENHOWER CVN 69
City	:	FPO
State	:	AE
Zip	:	09532-3627
Country	:	US
Telephone Number	:	757-443-7842
Fax Number	:

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

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	04/11/2018

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