1750510327 NPI number — NATHANIEL SOUTAR RIAL MD/PHD/MPH

Table of content: NATHANIEL SOUTAR RIAL MD/PHD/MPH (NPI 1750510327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750510327 NPI number — NATHANIEL SOUTAR RIAL MD/PHD/MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIAL
Provider First Name:
NATHANIEL
Provider Middle Name:
SOUTAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD/PHD/MPH
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:
1750510327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BREWSTER BLVD
Provider Second Line Business Mailing Address:
NAVAL HOSPITAL
Provider Business Mailing Address City Name:
CAMP LEJEUNE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28547-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-450-4159
Provider Business Mailing Address Fax Number:
910-450-4194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAL HOSPITAL
Provider Second Line Business Practice Location Address:
100 BREWSTER BLVD
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AA
Provider Business Practice Location Address Postal Code:
28547-2538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-450-4159
Provider Business Practice Location Address Fax Number:
910-450-4194
Provider Enumeration Date:
07/04/2009

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: 207R00000X , with the licence number:  R71672 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: R71672 . This is a "ARIZONA MEDICAL BOARD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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