Individual
MR. AMILCAR IVAN RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
1975 COMBAT MEDIC DR, FORT BRAGG, NC 28310-0001
(910) 396-4240
Mailing address
136 IVY STONE DR, RAEFORD, NC 28376-7381
(910) 396-4240
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
NC
Other
Enumeration date
10/09/2012
Last updated
10/09/2012
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