Provider Demographics
NPI:1528210374
Name:HUCKLEBERRY, JOHN WESLEY II (HMC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WESLEY
Last Name:HUCKLEBERRY
Suffix:II
Gender:M
Credentials:HMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15274
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-0274
Mailing Address - Country:US
Mailing Address - Phone:614-657-5188
Mailing Address - Fax:
Practice Address - Street 1:UNIT 100236 DRAWER 2703
Practice Address - Street 2:USS DWIGHT D EISENHOWER CVN 69
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09532-3627
Practice Address - Country:US
Practice Address - Phone:757-443-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider