Provider Demographics
NPI:1023021748
Name:HIMES, DAVID WELDON (HM1)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WELDON
Last Name:HIMES
Suffix:
Gender:M
Credentials:HM1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HORNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3007
Mailing Address - Country:US
Mailing Address - Phone:808-551-6667
Mailing Address - Fax:
Practice Address - Street 1:NAVAL UNDERSEA MEDICAL INSTITUTE
Practice Address - Street 2:BLDG 159
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-5159
Practice Address - Country:US
Practice Address - Phone:860-694-2876
Practice Address - Fax:860-694-3874
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman