Provider Demographics
NPI:1164033197
Name:BJERKE, BRIAN DAVID (SOIDC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:BJERKE
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 EVERETT YOPP DR
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-9449
Mailing Address - Country:US
Mailing Address - Phone:248-835-5470
Mailing Address - Fax:
Practice Address - Street 1:612 EVERRETT CREEK ROAD
Practice Address - Street 2:
Practice Address - City:SNEAD'S FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460
Practice Address - Country:US
Practice Address - Phone:910-440-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman