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Individual

MR. GEORGE ALAN LADD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
IDC

Contact information

Practice address
2D MARDIV, PSC BOX 2088, CAMP LEJEUNE, NC 28542
(910) 451-2789
Mailing address
5320 FAN PALM AVE, COCOA, FL 32927-2004
(305) 491-3062

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1710-1002X
IDC
Enumeration date
05/10/2013
Last updated
05/10/2013
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