Provider Demographics
NPI:1083803555
Name:BEDINGFIELD, JAMES CARL (IDC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CARL
Last Name:BEDINGFIELD
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 1:304 BOXWOOD STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058
Mailing Address - Country:US
Mailing Address - Phone:760-214-6248
Mailing Address - Fax:
Practice Address - Street 1:31 AREA BRANCH MEDICAL CLINIC
Practice Address - Street 2:BLDG. 310514
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92054
Practice Address - Country:US
Practice Address - Phone:760-725-7135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman