1932735800 NPI number — SHAUN PETER ROBERTS IDC

Table of content: SHAUN PETER ROBERTS IDC (NPI 1932735800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932735800 NPI number — SHAUN PETER ROBERTS IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
SHAUN
Provider Middle Name:
PETER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932735800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3D DEN :BN 3MLG
Provider Second Line Business Mailing Address:
UNIT 38450 FPO AP 96373 8450
Provider Business Mailing Address City Name:
OKINAWA
Provider Business Mailing Address State Name:
CAMP FOSTER
Provider Business Mailing Address Postal Code:
96373
Provider Business Mailing Address Country Code:
JP
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3D DEN :BN 3MLG
Provider Second Line Business Practice Location Address:
UNIT 38450 FPO AP 96373 8450
Provider Business Practice Location Address City Name:
OKINAWA
Provider Business Practice Location Address State Name:
CAMP FOSTER
Provider Business Practice Location Address Postal Code:
96373
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
98-954-7539
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)