Provider Demographics
NPI:1629260443
Name:DESSEL, BRIAN J (HM1 IDC, USN)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:DESSEL
Suffix:
Gender:M
Credentials:HM1 IDC, USN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SEWELLS POINT MEDICAL CLINIC
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:23456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 ADMIRAL TAUSSIG BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-6349
Practice Address - Country:US
Practice Address - Phone:757-555-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman