Provider Demographics
NPI:1215604723
Name:NEARY, BRADLEY K (USN IDC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:K
Last Name:NEARY
Suffix:
Gender:M
Credentials:USN IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JOINT EXPEDITIONARY BASE
Mailing Address - Street 2:SPECIAL BOAT TEAM 20
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JOINT EXPEDITIONARY BASE
Practice Address - Street 2:SPECIAL BOAT TEAM 20
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:23455
Practice Address - Country:US
Practice Address - Phone:760-583-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman