Provider Demographics
NPI:1063938967
Name:SEARS, SCOTT THOMAS (SURFACE IDC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:SEARS
Suffix:
Gender:M
Credentials:SURFACE IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1ST MARINE LOGISTICS GROUP
Mailing Address - Street 2:MEDICAL BATTALION
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1ST MARINE LOGISTICS GROUP
Practice Address - Street 2:MEDICAL BATTALION
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-201-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman