Provider Demographics
NPI:1922773803
Name:TOMERLIN, JOHN HUNTER
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HUNTER
Last Name:TOMERLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ELIZABETH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36180 3D RECON BN
Practice Address - Street 2:
Practice Address - City:NAHA
Practice Address - State:OKINAWA
Practice Address - Zip Code:96389
Practice Address - Country:JP
Practice Address - Phone:315-625-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
11201988TJOtherUSSOCOM-DOD