Provider Demographics
NPI:1538316724
Name:PITTMAN, DONALD DWAYNE (USN IDC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:DWAYNE
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:USN IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SHADY KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-9411
Mailing Address - Country:US
Mailing Address - Phone:910-916-2568
Mailing Address - Fax:
Practice Address - Street 1:PSC BOX 20106
Practice Address - Street 2:MARINE SPECIAL OPERATIONS ADVISOR GROUP
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:910-916-2568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman