Provider Demographics
NPI:1245536994
Name:SMITH, AARON BRADLEY (IDMT)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:BRADLEY
Last Name:SMITH
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 AMDS/SGPF
Mailing Address - Street 2:2501 CAPEHART RD
Mailing Address - City:OFFUTT AFB
Mailing Address - State:NE
Mailing Address - Zip Code:68113
Mailing Address - Country:US
Mailing Address - Phone:402-232-7346
Mailing Address - Fax:
Practice Address - Street 1:EHRLING BERGQUIST CLINIC
Practice Address - Street 2:2501 CAPEHART RD
Practice Address - City:OFFUTT AFB
Practice Address - State:NE
Practice Address - Zip Code:68113
Practice Address - Country:US
Practice Address - Phone:402-232-7346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians