NPI 1043506488

Samuel Winston, IDC

Practitioner Independent Duty Corpsman Fpo, AE

Practice location

Address: Uss Gonzalez Ddg 66, Fpo, AE 09570-1284
Phone: (757) 445-6269
Mailing address: 3828 Broadleaf CT, Virginia Beach, VA 23453-2135

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

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Registry record

NPI: 1043506488
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Jun 2011
Record last updated: 23 Jun 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.