Provider Demographics
NPI:1154323665
Name:US NAVY
Entity Type:Organization
Organization Name:US NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:760-577-6491
Mailing Address - Street 1:PO BOX 110193
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-5050
Mailing Address - Country:US
Mailing Address - Phone:760-252-0533
Mailing Address - Fax:
Practice Address - Street 1:MCLB BARSTOW
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-5050
Practice Address - Country:US
Practice Address - Phone:760-252-0533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1060858261QM1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient