Provider Demographics
NPI:1689987463
Name:STAPLETON, CURTISS DEE (IDC)
Entity Type:Individual
Prefix:
First Name:CURTISS
Middle Name:DEE
Last Name:STAPLETON
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 1:10 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1639
Mailing Address - Country:US
Mailing Address - Phone:860-514-6841
Mailing Address - Fax:
Practice Address - Street 1:USS MIAMI SSN-755
Practice Address - Street 2:MEDICAL DEPARTMENT REPRESENTATIVE
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09578-2411
Practice Address - Country:US
Practice Address - Phone:860-694-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman