Healthcare Provider Details

I. General information

NPI: 1083803555
Provider Name (Legal Business Name): JAMES CARL BEDINGFIELD IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 AREA BRANCH MEDICAL CLINIC BLDG. 310514
CAMP PENDLETON CA
92054
US

IV. Provider business mailing address

304 BOXWOOD STREET NORTH
OCEANSIDE CA
92058
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-7135
  • Fax:
Mailing address:
  • Phone: 760-214-6248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: