Provider Demographics
NPI:1831442334
Name:REECE, WILLIAM ELTON (IDC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ELTON
Last Name:REECE
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:MEDICAL DEPARTMENT PSC 564 BOX 80
Mailing Address - Street 2:FPO AP 96387
Mailing Address - City:CAMP FUJI
Mailing Address - State:JAPAN
Mailing Address - Zip Code:96387
Mailing Address - Country:JP
Mailing Address - Phone:315-224-8338
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL DEPARTMENT PSC 564 BOX 80
Practice Address - Street 2:FPO AP 96387
Practice Address - City:CAMP FUJI
Practice Address - State:JAPAN
Practice Address - Zip Code:96387
Practice Address - Country:JP
Practice Address - Phone:315-224-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman