NPI 1013787357
Bradley Arthur Gannon, IDC
Practice location
- Address
- 2d Recon Bn 2d Marine Division, Camp Lejeune, NC 28546
- Phone
- (910) 440-7703
- Mailing address
- A-71 2d Recon Bn 2d Marine Division, Camp Lejeune, NC 28546
Registered specialties
Independent Duty Corpsman
Primary
Registry record
- NPI
- 1013787357
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 8 Jan 2024
- Record last updated
- 8 Jan 2024
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.