Provider Demographics
NPI:1770805954
Name:PITTS, JAMES RYAN (IDC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RYAN
Last Name:PITTS
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 1:11899 SPRUCE RUN DR APT A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-4764
Mailing Address - Country:US
Mailing Address - Phone:858-243-3031
Mailing Address - Fax:
Practice Address - Street 1:2005 KNIGHT LANE
Practice Address - Street 2:BLDG. H NAVY MEDICINE SUPPORT COMMAND
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:760-725-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman