Provider Demographics
NPI:1396005583
Name:DFAS-CL/JFLB
Entity Type:Organization
Organization Name:DFAS-CL/JFLB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT DUTY CORPSMAN
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:IDC
Authorized Official - Phone:850-390-1718
Mailing Address - Street 1:12092 HARMONY CIR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-9524
Mailing Address - Country:US
Mailing Address - Phone:850-390-1718
Mailing Address - Fax:
Practice Address - Street 1:12092 HARMONY CIR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-9524
Practice Address - Country:US
Practice Address - Phone:850-390-1718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital