Individual
DANIEL JOHN CALLICOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
BLDG RR 361, CAMP LEJEUNE, NC 28540
(910) 440-2504
Mailing address
BLDG RR 361, CAMP LEJEUEN, NC 28540
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
12/01/2022
Last updated
12/01/2022
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