Provider Demographics
NPI:1760691547
Name:HIGHLEY, DONALD PAUL JR (INDEPENDENT DUTY COR)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:PAUL
Last Name:HIGHLEY
Suffix:JR
Gender:M
Credentials:INDEPENDENT DUTY COR
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Mailing Address - Street 1:3929 TWO OAKS RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2647
Mailing Address - Country:US
Mailing Address - Phone:757-638-9426
Mailing Address - Fax:
Practice Address - Street 1:USS JAMES E, WILLIAMS (DDG 95)
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:09575-1204
Practice Address - Country:US
Practice Address - Phone:757-444-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians