Provider Demographics
NPI:1245731322
Name:DAKIS, HARLEY (SFIDC)
Entity type:Individual
Prefix:
First Name:HARLEY
Middle Name:
Last Name:DAKIS
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 480 BOX 60
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96370-0001
Mailing Address - Country:US
Mailing Address - Phone:360-932-4040
Mailing Address - Fax:
Practice Address - Street 1:PSC 480 BOX 60
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96370-0001
Practice Address - Country:US
Practice Address - Phone:360-932-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman