1235181058 NPI number — MR. DANIEL WILLIAM FEEBACK IDC

Table of content: MR. DANIEL WILLIAM FEEBACK IDC (NPI 1235181058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235181058 NPI number — MR. DANIEL WILLIAM FEEBACK IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEEBACK
Provider First Name:
DANIEL
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IDC
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:
1235181058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4121 SHORELINE CIR APT 118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23452-2165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-469-9642
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
667 JOHN PAUL JONES CIR NAVAL MEDICAL CENTER PORTSMOUTH
Provider Second Line Business Practice Location Address:
MEDICAL DEPARTMENT(CODE NO2M)
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23511-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-443-0026
Provider Business Practice Location Address Fax Number:
757-443-5706
Provider Enumeration Date:
05/17/2006

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" .

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

  • Identifier: 1710I1002X . This is a "INDEPENDENT DUTY CORPSMAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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