Individual
JOE CABALHIN DITTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
90 HOPE DR BLDG 6000, MOUNTAIN HOME A F B, ID 83648-1062
(208) 828-7313
Mailing address
8019 BRADT CT, MOUNTAIN HOME A F B, ID 83648-1064
(208) 832-1067
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
07/22/2009
Last updated
07/22/2009
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