Provider Demographics
NPI:1063643708
Name:JANIC, WILLIAM ROBERT JR
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:JANIC
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS FITZGERALD
Mailing Address - Street 2:DDG 62
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96665-1280
Mailing Address - Country:US
Mailing Address - Phone:0906-111-3453
Mailing Address - Fax:
Practice Address - Street 1:USS FITZGERALD
Practice Address - Street 2:DDG 62
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96665-1280
Practice Address - Country:US
Practice Address - Phone:0906-111-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider