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Individual

MR. PETER MORENO IV

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
SOIDC

Contact information

Practice address
PSC BOX 20183, 2D MARINE SPECIAL OPERATIONS BATTALION, CAMP LEJEUNE, NC 28542-0116
(910) 440-7704
Mailing address
PSC BOX 20183, 2D MARINE SPECIAL OPERATIONS BATTALION, CAMP LEJEUNE, NC 28542-0183
(910) 440-7704

Taxonomy

Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary

Other

Enumeration date
10/12/2011
Last updated
10/12/2011
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