Individual
BRIAN C DESOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544-5613
(850) 881-4595
Mailing address
34 BAKKE ST, HURLBURT FIELD, FL 32544-1046
(850) 226-3882
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
02/04/2013
Last updated
02/04/2013
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