Provider Demographics
NPI:1942574272
Name:1ST RECON BATTALION MEDICAL
Entity type:Organization
Organization Name:1ST RECON BATTALION MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BATTALION SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-725-8912
Mailing Address - Street 1:1ST RECON BN MEDICAL
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:760-725-8912
Mailing Address - Fax:
Practice Address - Street 1:562 OLYMPIC WAY
Practice Address - Street 2:APT L
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7925
Practice Address - Country:US
Practice Address - Phone:760-725-8912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center