Provider Demographics
NPI:1073797452
Name:WEBB, DUSTY ALAN (SFIDC)
Entity Type:Individual
Prefix:
First Name:DUSTY
Middle Name:ALAN
Last Name:WEBB
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS HARRY S TRUMAN
Mailing Address - Street 2:BOX 80
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USS HARRY S TRUMAN
Practice Address - Street 2:BOX 80
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09524
Practice Address - Country:US
Practice Address - Phone:757-444-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman