Provider Demographics
NPI:1992880314
Name:POULARD, HERVE (PA-C)
Entity type:Individual
Prefix:MR
First Name:HERVE
Middle Name:
Last Name:POULARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 45004 BOX 214
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:TOKYO
Mailing Address - Zip Code:AP
Mailing Address - Country:JP
Mailing Address - Phone:0118133-224-5000
Mailing Address - Fax:
Practice Address - Street 1:US EMBASSY
Practice Address - Street 2:
Practice Address - City:TOKYO
Practice Address - State:MIATO-KU
Practice Address - Zip Code:AP
Practice Address - Country:JP
Practice Address - Phone:0118133-224-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101153363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical