Provider Demographics
NPI:1295897262
Name:FUTAGAWA, VERNE SHIZUO (RD)
Entity type:Individual
Prefix:MR
First Name:VERNE
Middle Name:SHIZUO
Last Name:FUTAGAWA
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 JUPITER ST
Mailing Address - Street 2:
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311-1011
Mailing Address - Country:US
Mailing Address - Phone:940-851-8564
Mailing Address - Fax:940-851-3850
Practice Address - Street 1:939 MISSILE RD
Practice Address - Street 2:
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-2263
Practice Address - Country:US
Practice Address - Phone:940-676-6617
Practice Address - Fax:940-676-3850
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered