Ivan Vicente, IDMT
NPI #1710201553 in Ellsworth Afb, South Dakota
Provider Information
- NPI Number
- 1710201553
- Entity Type
- Individual
- Name
- Ivan Vicente, IDMT
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Military Health Care Provider - Independent Duty Medical Technicians
- Credential
- IDMT
- Enumeration Date
- Mar 23, 2010
- Last Updated
- Mar 23, 2010
Practice Location
- Address
- 433 BLACK ELK CT
- City
- Ellsworth Afb
- State
- South Dakota
- ZIP Code
- 57706-1847
- Phone
- (605) 521-3502
Specialties & Taxonomy Codes
| Specialty |
|---|
| Military Health Care Provider - Independent Duty Medical Technicians — Independent Duty Medical Technicians |
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