Provider Demographics
NPI:1184039356
Name:SHIRD, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SHIRD
Suffix:
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 HARRY S TRUMAN
Mailing Address - Street 2:CVN 75
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09524-2875
Mailing Address - Country:US
Mailing Address - Phone:757-443-7882
Mailing Address - Fax:
Practice Address - Street 1:USS HARRY S TRUMAN
Practice Address - Street 2:CVN 75
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09524-2875
Practice Address - Country:US
Practice Address - Phone:757-443-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN