Provider Demographics
NPI:1548583347
Name:DILKS, RYAN WALTER (IDC)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:WALTER
Last Name:DILKS
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:COMMANDING OFFICER
Mailing Address - Street 2:USS TENNESSEE (SSBN 734)(BLUE)
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09588-2117
Mailing Address - Country:US
Mailing Address - Phone:757-636-5306
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER ATTN: MDR
Practice Address - Street 2:USS TENNESSEE (SSBN 734)(BLUE)
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09588-2117
Practice Address - Country:US
Practice Address - Phone:757-636-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman