Provider Demographics
NPI:1508061292
Name:COVELL, JEREMY S (IDC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:S
Last Name:COVELL
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 567
Mailing Address - Street 2:BOX 6634
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96384
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3RD MED BN 3RD FSSG
Practice Address - Street 2:BRAVO CO UNIT 38448
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604
Practice Address - Country:JP
Practice Address - Phone:623-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman