Provider Demographics
NPI:1801096540
Name:LABARR, MILTON R (IDC)
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:R
Last Name:LABARR
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 1:2212 CHERBOURG RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-2209
Mailing Address - Country:US
Mailing Address - Phone:757-445-6044
Mailing Address - Fax:
Practice Address - Street 1:COMMANDING OFFICER
Practice Address - Street 2:USS MONTEREY CG61 ATTN MEDICAL
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09578-1101
Practice Address - Country:US
Practice Address - Phone:757-963-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710I1002XOtherINDEPENDENT DUTY CORPSMAN