Organization
UNITED STATES AIR FORCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON ROBERT CROCKETT (PA STUDENT)
(318) 347-4651
Entity
Organization
Contact information
Practice address
6501 VEGAS DR APT 1034, LAS VEGAS, NV 89108-7773
(318) 347-4651
Mailing address
6501 VEGAS DR APT 1034, LAS VEGAS, NV 89108-7773
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
—
—
Other
Enumeration date
12/12/2008
Last updated
12/12/2008
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