MEDICARE: EDUARDO ERIC DE SOUZA I.D.M.T

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1891939781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO ERIC DE SOUZA I.D.M.T

Provider Business Mailing Address
First Line	:	51 AMDS
Second Line	:	PSC 3 BOX 3793
City	:	APO
State	:	AP
Zip	:	96266-0037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG 777
Second Line	:	UNIT 260
City	:	APO
State	:	AP
Zip	:	96266
Country	:	US
Telephone Number	:	31-661-2618
Fax Number	:

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

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	08/18/2009

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Directions to “ EDUARDO ERIC DE SOUZA I.D.M.T” Practice Location

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