Provider Demographics
NPI:1669608881
Name:ASTIN, JEREMY DON (IDMT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:DON
Last Name:ASTIN
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:DON
Other - Last Name:ASTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDMT
Mailing Address - Street 1:6900 ALDEN DR
Mailing Address - Street 2:
Mailing Address - City:FE WARREN AFB
Mailing Address - State:WY
Mailing Address - Zip Code:82005-3906
Mailing Address - Country:US
Mailing Address - Phone:307-773-4212
Mailing Address - Fax:
Practice Address - Street 1:6900 ALDEN DR
Practice Address - Street 2:
Practice Address - City:FE WARREN AFB
Practice Address - State:WY
Practice Address - Zip Code:82005-3906
Practice Address - Country:US
Practice Address - Phone:307-773-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians