Individual
HAARIS GEORGE BJOTVEDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC (SO-ATP)
Contact information
Practice address
2D MARINE RAIDER BATTALION, BATTALION AID STATION, PSC BOX 20183, CAMP LEJEUNE, NC 28542-0183
(910) 440-7704
Mailing address
409 RIDGEWAY DR, SNEADS FERRY, NC 28460-7613
(602) 809-0298
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
10243398HB
NC
Other
Enumeration date
07/28/2025
Last updated
07/28/2025
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