Retroyreo Demonza Conner, SUB IDC
Military Health Care Provider, Independent Duty Corpsman in Fpo, AE. Individual provider (NPI-1).
NPI number1881908382
StatusActive
Last updated in NPPESJul 27, 2010
Details
- NPI
- 1881908382
- Entity type
- Individual (NPI-1)
- Name
- Mr. Retroyreo Demonza Conner
- Credential
- SUB IDC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 27, 2010
- Last updated
- Jul 27, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1710I1002X | Military Health Care Provider, Independent Duty Corpsman | – | – | Yes |
Practice location
Uss New Mexico (Ssn 779)Fpo, AE 09524-2405
Phone 757-339-4621
Mailing address
88 Buckeye RdGroton, CT 06340-3000
Phone 757-339-4621
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