Organization
UNITED STATES AIR FORCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRED J PARKER (IDMT/SSGT)
(702) 404-1142
Entity
Organization
Contact information
Practice address
4250 GRIFFISS AVE, NELLIS AFB, NV 89191-7018
(702) 404-1142
Mailing address
4250 GRIFFISS AVE, NELLIS AFB, NV 89191-7018
(702) 404-1142
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
07/27/2009
Last updated
07/27/2009
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