Provider Demographics
NPI:1154539658
Name:SEXTON, PAUL DAVID (IDC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DAVID
Last Name:SEXTON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D MLG CLR 37
Mailing Address - Street 2:KGAS UNIT 38404
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96604-8404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3D MLG CLR 37
Practice Address - Street 2:KGAS UNIT 38404
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-8404
Practice Address - Country:US
Practice Address - Phone:0803-362-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman