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ROBERT LEE KING IDC

Independent Duty Corpsman >> Military Health Care Provider >> Other Service Providers

Registrant NPI Number: 1982667804

Individual Registrant:
 ROBERT LEE KING IDC
Gender: M

Location and contact information for practice:
NAVAL BRANCH HEALTH CLINIC 2104 MASSEY AVENUE, MAYPORT, FL 32228 US
Tel: 904-270-4241  Fax: --

Contact information for business:
12955 CANYON CREEK TRL S  JACKSONVILLE, FL 32246-6652 US
Tel: 904-992-9095  Fax: --

Registration Information:
NPI: 1982667804
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1710I1002XOther Service Providers
Military Health Care Provider
Independent Duty Corpsman

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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