Provider Demographics
NPI:1558658757
Name:SWEET, GARY JAMES (IDC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:JAMES
Last Name:SWEET
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 1:7 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1920
Mailing Address - Country:US
Mailing Address - Phone:607-331-9683
Mailing Address - Fax:
Practice Address - Street 1:1 AYRES CIRCLE, BLDG. H-1, PNSY
Practice Address - Street 2:NAVAL BRANCH HEALTH CLINIC
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03804
Practice Address - Country:US
Practice Address - Phone:207-438-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman