Individual
TERRY DWAYNE SHOULDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
3402 TARAWA RD., SPECIAL BOAT TEAM TWELVE MEDICAL DEPARTMENT, SAN DIEGO, CA 92155-5003
(619) 437-5540
Mailing address
3375 GREGORY ST, SAN DIEGO, CA 92104-4751
(760) 668-5569
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
11/06/2008
Last updated
11/06/2008
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