MR. RUDY J LOPEZ (NPI# 1114284809) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114284809 |
| Entity Type | Individual |
| Full Name | MR. RUDY J LOPEZ |
| Credential | SO-IDC |
| Practice Address |
Joint Special Operations Medical Ctr Usajfkswcs Stop A., 3004 Ardennes St. Fort Bragg NC 28310-9610 |
| Practice Telephone | 9103697775 |
| Mailing Telephone | 9103697775 |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2012-04-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
NEC HM8403 | NC | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669550216 | Rudy S. Lopez | Pediatrics | 1150 Veterans Blvd, Redwood City, CA 94063-2037 | 2006-11-01 |
| Street Address |
JOINT SPECIAL OPERATIONS MEDICAL CTR USAJFKSWCS STOP A., 3004 ARDENNES ST. |
| City | FORT BRAGG |
| State | NC |
| Zip Code | 28310-9610 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013550763 | Brent Francis Bachman | Physician Assistant | 2817 Reilly Street, Fort Bragg, NC 28310 | 2019-10-25 |
| 1417503459 | Cooper Pasque | Dentist | 1838 Normandy Dr., Fort Bragg, Apo, AA 28310 | 2019-08-15 |
| 1851959951 | Daniel Jordan Whitaker | Student in an Organized Health Care Education/Training Program | Womack Army Medical Center, 2817 Reilly Road, Mcxc-cod Credentials, Fort Bragg, NC 28310 | 2019-06-03 |
| 1679054217 | Christopher Cetnar | Dentist | Smokebomb Hill, Bldg 3718 Gruber Road, Fort Bragg, NC 28310 | 2018-08-22 |
| 1316427107 | Alexandrea Lee Clark | Dentist | Laflamme Dental Clinic, Bldg C6238 Ardennes Road, Fort Bragg, NC 28310 | 2018-08-21 |
| 1457843831 | Kevin Patrick Hudson | Student in an Organized Health Care Education/Training Program | 2817 Reilly Road Mxcx - Cod Credentials, Womack Army Medical Center, Fort Bragg, NC 28310 | 2018-06-01 |
| 1639691462 | Margaret S Greene | Dentist | Usa Dental Health Activity Fort Bragg, Wamc Box #151 2817 Rielly Rd, Fort Bragg, NC 28310 | 2017-07-13 |
| 1912432246 | Chezdan Baker | Student in an Organized Health Care Education/Training Program | Us Army Dental Health Activity Bldg-6837 Normandy Drive, Fort Bragg, NC 28310 | 2017-04-24 |
| 1215483094 | Shantryce Monique Boatwright Crump | Dental Hygienist | 2617 Rielly Road, Fort Bragg, NC 28310 | 2016-08-31 |
| 1629435714 | John Gagnier | Physician Assistant | Gruber Road, Building #c-1722, Fort Bragg, NC 28310 | 2016-01-21 |
| Find all providers in zip 28310 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| 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. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194077677 | Amilcar Ivan Rodriguez | Military Health Care Provider | 1975 Combat Medic Dr, Fort Bragg, NC 28310-0001 | 2012-10-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820002 | Levi Para | Military Health Care Provider | 2d Reconnaissance Bn, Psc 20138, Camp Lejeune, NC 28452-0138 | 2020-10-29 |
| 1427661743 | Russ C Garlinghouse | Military Health Care Provider | Rr 616, Stone Bay, NC 28460 | 2020-08-26 |
| 1164033197 | Brian David Bjerke | Military Health Care Provider | 612 Everrett Creek Road, Snead's Ferry, NC 28460 | 2020-08-13 |
| 1588274641 | Adam Randolph Smith | Military Health Care Provider | 205 Wintergreen Ln, Hubert, NC 28539-4659 | 2020-08-04 |
| 1588273999 | Jacob Johnson | Military Health Care Provider | 413 Salvo Ct, Holly Ridge, NC 28445-8609 | 2020-07-31 |
| 1790309565 | Jason C Smith | Military Health Care Provider | 113 Barrington Ct, Maple Hill, NC 28454-8659 | 2020-06-08 |
| 1639793748 | Johnathon T Brewer | Military Health Care Provider | 100 White St, Jacksonville, NC 28540 | 2020-06-04 |
| 1003444928 | Andres Martin Rodoni | Military Health Care Provider | 2nd Reconnaissance Battalion, Camp Lejune, NC 28542 | 2020-03-27 |
| 1699306670 | Dominick Ciampo | Military Health Care Provider | A66 Boat Basin Road, Camp Lejeune, NC 28542 | 2020-01-29 |
| 1487294682 | Daniel Scott Porterfield | Military Health Care Provider | Building Rr612, Loop Rd, Sneads Ferry, NC 28460 | 2020-01-15 |
| Find all providers with the same taxonomy | ||||
| City | FORT BRAGG |
| Zip Code | 28310 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.