Provider Demographics
NPI:1821078346
Name:LIBBY, BRENT DALEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:DALEE
Last Name:LIBBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:7 PLEASANT PLACE CT
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1187
Mailing Address - Country:US
Mailing Address - Phone:843-524-0743
Mailing Address - Fax:
Practice Address - Street 1:ATTN: MEDICAL STAFF SERVICES BLDG. H 2005 KNIGHT LANE
Practice Address - Street 2:NAVY MEDICINE SUPPORT COMMAND
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:904-542-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012322812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology