Individual
SERGEOUS EVGENEY ANIKIN-DICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2D MARINE RAIDER BATTALION PSC 20183, CAMP LEJEUNE, NC 28542
(910) 440-7714
Mailing address
181 PEYTONS RIDGE DR, HUBERT, NC 28539-3983
(570) 439-6591
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/27/2018
Last updated
09/27/2018
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