Matthew Coleman, SFIDC

Individual provider Active NPI Independent Duty Corpsman · Gulfport, MS

NPI 1770907412 · NPPES record last updated Feb 18, 2014

Key facts

NPI
1770907412
Entity type
Individual (NPI type 1)
Primary specialty
Independent Duty Corpsman 1710I1002X
Practice address
NBHC Naval Construction Battalion Center Gulfport
5501 Marvin Shields Blvd
Gulfport, MS 39501
Phone
(228) 871-2810
NPI assigned
Feb 18, 2014
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Independent Duty Corpsman 1710I1002X Yes

Addresses

Primary practice location

NBHC Naval Construction Battalion Center Gulfport
5501 Marvin Shields Blvd
Gulfport, MS 39501

Mailing address

18378 Cardinal LN
Gulfport, MS 39503-5594

Other providers in Gulfport, MS

All providers in Gulfport, MS · Independent Duty Corpsman in Mississippi

Sources for this page

Verify at the official NPI Registry.