Individual
JOHN LAYNE BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
2D MARINE RAIDER BATTALION, PSC BOX 20183, CAMP LEJEUNE, NC 28542-0183
(208) 312-1165
Mailing address
2D MARINE RAIDER BATTALION, PSC BOX 20183, CAMP LEJEUNE, NC 28542-0183
(208) 312-1165
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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