NPIMap

Organization Active NPI

Department of Defense

  • Medical Physician Assistant
  • Fort Gordon, GA
National Provider Identifier
1851668834
Registry record updated Nov 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0010-02514 Issued in NC
Legal business name
DEPARTMENT OF DEFENSE
Practice address
41St Street
BLDG 40709 Room 207 Ddeamc; Meb, Pad
Fort Gordon, GA 30905
Phone
(706) 787-1102
NPI assigned
Nov 19, 2011
Last updated
Nov 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Hector Luis Luna, PA-C
Title
Captain/Physician's Assistant
Phone
(706) 787-1102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0010-02514 NC Primary

Addresses

Primary practice location

41St Street
BLDG 40709 Room 207 Ddeamc; Meb, Pad
Fort Gordon, GA 30905

Mailing address

41St Street
BLDG 40709 Room 207 Ddeamc; Meb, Pad
Fort Gordon, GA 30905
Phone (706) 787-1102

National Provider Directory

National Provider Directory
Tax ID family
United States Army10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321660800000",
    "number": "1851668834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41ST STREET",
            "address_2": "BLDG 40709 ROOM 207 DDEAMC; MEB, PAD",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "30905",
            "telephone_number": "706-787-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41ST STREET",
            "address_2": "BLDG 40709 ROOM 207 DDEAMC; MEB, PAD",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "30905",
            "telephone_number": "706-787-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF DEFENSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-19",
        "last_updated": "2011-11-19",
        "status": "A",
        "authorized_official_last_name": "LUNA",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "CAPTAIN/PHYSICIAN'S ASSISTANT",
        "authorized_official_telephone_number": "706-787-1102",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-02514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Gordon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.