MEDICARE: MR. MILTON R LABARR 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1710I1002X	OTHER	VA	INDEPENDENT DUTY CORPSMAN

General Provider Information

NPI Number	:	1801096540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MILTON R LABARR IDC

Provider Business Mailing Address
First Line	:	2212 CHERBOURG RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-2209
Country	:	US
Telephone Number	:	757-445-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	COMMANDING OFFICER
Second Line	:	USS MONTEREY CG61 ATTN MEDICAL
City	:	FPO
State	:	AE
Zip	:	09578-1101
Country	:	US
Telephone Number	:	757-963-0007
Fax Number	:

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

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	04/20/2008

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