Healthcare Provider Details

I. General information

NPI: 1962816009
Provider Name (Legal Business Name): BRENT PASSEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 08/13/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 99, UNIT 5024
MISAWA AIR BASE AOMORI-KEN
0330012
JP

IV. Provider business mailing address

PSC 76 BOX 1008
APO AP
96319
US

V. Phone/Fax

Practice location:
  • Phone: 315-226-6647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number1389
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number1389
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1389
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1389
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: