Provider Demographics
NPI:1881788834
Name:US ARMY
Entity type:Organization
Organization Name:US ARMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:JIRAU-ROSALY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-458-2411
Mailing Address - Street 1:42 NE PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-8850
Mailing Address - Country:US
Mailing Address - Phone:580-529-2142
Mailing Address - Fax:
Practice Address - Street 1:42 NE PHEASANT LN
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-8850
Practice Address - Country:US
Practice Address - Phone:580-529-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059043A171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty