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Individual

DANE J TACKITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
IDMT

Contact information

Practice address
7338 LONCKI ST, HILL AFB, UT 84056-7300
(801) 777-4710
Mailing address
7338 LONCKI ST, HILL AFB, UT 84056-7300

Taxonomy

Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary

Other

Enumeration date
07/20/2009
Last updated
07/20/2009
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