Provider Demographics
NPI:1932335049
Name:ROUZAN, ANDRE LAMONTE (IDMT)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:LAMONTE
Last Name:ROUZAN
Suffix:
Gender:M
Credentials:IDMT
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Other - Credentials:
Mailing Address - Street 1:RR# 2 BOX 5425
Mailing Address - Street 2:CAMP BULLIS
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257
Mailing Address - Country:US
Mailing Address - Phone:210-295-8337
Mailing Address - Fax:210-295-8191
Practice Address - Street 1:RR# 2 BOX 5425
Practice Address - Street 2:CAMP BULLIS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257
Practice Address - Country:US
Practice Address - Phone:210-295-8337
Practice Address - Fax:210-295-8191
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians