NPI 1780044362

Ian Prudhomme, MD

Practitioner Anatomic Pathology & Clinical Pathology Physician Apo, AA

Practice location

Address: 2200 Bergquist Dr STE 1 Whmc/Ge-2200, Jbsa Lackland Afb, Tx, Apo, AA 78236-5300
Phone: (423) 943-2720
Mailing address: 2200 Bergquist Dr STE 1 Whmc/Ge-2200, Jbsa Lackland Afb, TX 78236-5300

Registered specialties

Anatomic Pathology & Clinical Pathology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207ZP0102X Licence 30410 (NE)

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Registry record

NPI: 1780044362
Entity type: Individual
Sex (as registered): Male
NPI issued: 25 Feb 2016
Record last updated: 8 Jan 2024

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.