Provider Demographics
NPI:1972715613
Name:DOZIER, JUAN TERRELL (IDC)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:TERRELL
Last Name:DOZIER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:MR
Other - First Name:JUAN
Other - Middle Name:TERRELL
Other - Last Name:DOZIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IDC
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NC
Mailing Address - Zip Code:28421-0430
Mailing Address - Country:US
Mailing Address - Phone:910-283-0616
Mailing Address - Fax:
Practice Address - Street 1:PSC BOX 8023
Practice Address - Street 2:
Practice Address - City:CHERRY POINT
Practice Address - State:NC
Practice Address - Zip Code:28533
Practice Address - Country:US
Practice Address - Phone:910-466-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman