Provider Demographics
NPI:1134562507
Name:SOERGEL, CHRISTOPHER PAUL (IDC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:SOERGEL
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:MOBILE DIVING AND SALVAGE UNIT ONE
Mailing Address - Street 2:BUILDING 17 BISHOP POINT
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:96660-7005
Mailing Address - Country:US
Mailing Address - Phone:808-471-0755
Mailing Address - Fax:
Practice Address - Street 1:MOBILE DIVING AND SALVAGE UNIT ONE
Practice Address - Street 2:BUILDING 17 BISHOP POINT
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:96660-7005
Practice Address - Country:US
Practice Address - Phone:808-471-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians