1497064430 NPI number — MR. LENNARD EARL SMALL JR. SFIDC

Table of content: MR. LENNARD EARL SMALL JR. SFIDC (NPI 1497064430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497064430 NPI number — MR. LENNARD EARL SMALL JR. SFIDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMALL
Provider First Name:
LENNARD
Provider Middle Name:
EARL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
SFIDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497064430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USS JOHN L HALL FFG 32
Provider Second Line Business Mailing Address:
MEDICAL
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AA
Provider Business Mailing Address Postal Code:
34091-1488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-270-6541
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USS JOHN L. HALL (FFG-32)
Provider Second Line Business Practice Location Address:
MEDICAL DEPARTMENT
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AA
Provider Business Practice Location Address Postal Code:
34091-1448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-270-6541
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1710I1002X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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