Provider Demographics
NPI:1164681623
Name:SWEET, RICHARD A JR (SFIDC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:SWEET
Suffix:JR
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 THACH FFG 43
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96679-1498
Mailing Address - Country:US
Mailing Address - Phone:619-532-5103
Mailing Address - Fax:
Practice Address - Street 1:USS THACH FFG 43
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96679-1498
Practice Address - Country:US
Practice Address - Phone:619-532-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman