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Individual

CHRISTOPHER LEE ROY SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
SUBMARINE IDC

Contact information

Practice address
USS SAN JUAN (SSN 751), GROTON, CT 06349
(910) 650-4616
Mailing address
36 BAYBERRY HILL RD, NORWICH, CT 06360-1435
(910) 650-4616

Taxonomy

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

Other

Enumeration date
09/23/2019
Last updated
09/23/2019
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