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MR. BRYAN JUDSON SMITH DIVE IDC
NPI 1457633711
Military Health Care Provider - Independent Duty Corpsman in San Diego, CA

Active since September 13, 2011
34101 FARENHOLT AVE, SAN DIEGO, CA 92134(619) 532-6064 Get Directions Write a Review

NPPES record last updated: September 13, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mr. Bryan Judson Smith Dive Idc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. BRYAN JUDSON SMITH DIVE IDC (NPI 1457633711) is an individual independent duty corpsman provider in San Diego, California and active in the NPI registry since September 2011.

NPPES Registry Identity

NPI1457633711
Entity TypeIndividualMale
Primary Taxonomy1710I1002X
Provider Legal NameMR. BRYAN JUDSON SMITHCredential: DIVE IDC
Location Address34101 FARENHOLT AVESan Diego, CA 92134-7000
Mailing Address62468 Highway 49Lineville, AL 36266-4923 · (240) 478-1870
Phone(619) 532-6064
Sole ProprietorYes
Enumeration DateSeptember 13, 2011
✔ NPI 1457633711 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMilitary Health Care Provider · Independent Duty CorpsmanOther Service Providers
Taxonomy Code1710I1002X
Definition
A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.
34101 FARENHOLT AVE, San Diego, CA 92134
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHRISTOPHER A WALLACE IDC
Military Health Care Provider (Independent Duty Corpsman)
34101 FARENHOLT AVE
SAN DIEGO, CA 92134
San Diego County (619) 532-7801
MR. GABRIEL A MICHAELS IDC
Military Health Care Provider (Independent Duty Corpsman)
34101 FARENHOLT AVE
SAN DIEGO, CA 92134
San Diego County (216) 701-4316
MR. GABRIEL JOSE SAN PEDRO IDC
Military Health Care Provider (Independent Duty Corpsman)
34101 FARENHOLT AVE
SAN DIEGO, CA 92134
San Diego County (619) 532-7968
ALEXANDER BOX
Military Health Care Provider (Independent Duty Corpsman)
34101 FARENHOLT AVE
SAN DIEGO, CA 92134
San Diego County (843) 605-3091
CHANTE ALLI MOORE
Military Health Care Provider (Independent Duty Corpsman)
34101 FARENHOLT AVE
SAN DIEGO, CA 92134
San Diego County (215) 681-7866
MR. STEVEN R CURRIER JR. SURFACE IDC
Military Health Care Provider (Independent Duty Corpsman)
34101 FARENHOLT AVE
SAN DIEGO, CA 92134
San Diego County (619) 532-7968
MARCO OLIVAREZ
Military Health Care Provider (Independent Duty Corpsman)
34101 FARENHOLT AVE
SAN DIEGO, CA 92134
San Diego County (619) 532-7968
MR. ANDREW BUD TAYLOR IDC
Military Health Care Provider (Independent Duty Corpsman)
34101 FARENHOLT AVE, BLDG 14
SAN DIEGO, CA 92134
San Diego County (619) 532-6233

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bryan Smith's NPI number?

The NPI number for Bryan Smith is 1457633711. It was assigned to this individual provider in the NPPES registry on September 13, 2011.

Where is Bryan Smith located?

Bryan Smith practices at 34101 Farenholt Ave, San Diego, CA 92134. The listed phone number is (619) 532-6064.

What is Bryan Smith's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

When was this NPI record last updated?

The NPPES record for Bryan Smith was last updated on September 13, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.