Nomor : 890 / 2779 / 2019
Perihal : Isian data Personal
Data Personal
| No | Data Personal | Isian | Keterangan |
| 1 | NIP | 19710915 199403 1 006 | |
| 2 | Puskesmas | Puskesmas Padamara | |
| 3 | Nama | Achirul Soebagjo, S.Kep.,Ns. | |
| 4 | Tempat lahir | Purballingga | |
| 5 | Tgl/bln/ tahun lahir | 15 September 1971 | |
| 6 | Jenis kelamin | Laki – Laki | |
| 7 | Agama | Islam | |
| 8 | No Handphone 1 | 082 1360 35635 | |
| 9 | No Handphone 2 | 085 740 301235 | |
| 10 | Email puskesmas | puskesmaspadamara@gmail.com | |
| 11 | Email personal | achirulsoebagjo99@gmail.com | |
| 12 | No KTP | 330315 150971 0001 | |
| 13 | No NPWP | 79.910.193.6-529.000 | |
| 14 | No BPJS | 00000082821521 | |
| 15 | Status pegawai | PNS | |
| 16 | Alamat sesuai KTP | ||
| Jln | – | ||
| RT / RW | 01 / 03 | ||
| Desa/ Kel | Dawuhan | ||
| Kec | Padamara | ||
| Kab | Purballingga | ||
| Kode pos | 53372 | ||
| 17 | Alamat tempat tinggal | ||
| Jln | – | ||
| RT / RW | 01 / 03 | ||
| Desa/ Kel | Dawuhan | ||
| Kec | Padamara | ||
| Kab | Purballingga | ||
| Kode pos | 53372 |