1912553975 NPI number — BRANDON JOSEPH DAPPER SOIDC

Table of content: BRANDON JOSEPH DAPPER SOIDC (NPI 1912553975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912553975 NPI number — BRANDON JOSEPH DAPPER SOIDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAPPER
Provider First Name:
BRANDON
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SOIDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912553975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC BOX 20138, CAMP LEJEUNE, NC
Provider Second Line Business Mailing Address:
2D RECONNAISSANCE BATTALION, 2D MARINE DIVISION
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AA
Provider Business Mailing Address Postal Code:
28542-0138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-440-7703
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CAMP LEJEUNE, NC
Provider Second Line Business Practice Location Address:
2D RECONNAISSANCE BATTALION BATTALION AID STATION
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AA
Provider Business Practice Location Address Postal Code:
28542-0138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-440-7703
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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