MEDICARE: SARA LYNNE MATHSON 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

General Provider Information

NPI Number	:	1851550875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA LYNNE MATHSON IDC

Provider Business Mailing Address
First Line	:	PSC 475
Second Line	:	BOX 1444
City	:	FPO
State	:	AP
Zip	:	96350-9998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 475
Second Line	:	BOX 1444
City	:	FPO
State	:	AP
Zip	:	96350-9998
Country	:	US
Telephone Number	:	706-478-3626
Fax Number	:

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

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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Directions to “ SARA LYNNE MATHSON IDC” Practice Location

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