Provider Demographics
NPI:1891939781
Name:DE SOUZA, EDUARDO ERIC (IDMT)
Entity Type:Individual
Prefix:
First Name:EDUARDO ERIC
Middle Name:
Last Name:DE SOUZA
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 AMDS
Mailing Address - Street 2:PSC 3 BOX 3793
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96266-0037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 777
Practice Address - Street 2:UNIT 260
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96266
Practice Address - Country:US
Practice Address - Phone:031-661-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians