Healthcare Provider Details

I. General information

NPI: 1962784777
Provider Name (Legal Business Name): MR. BRITAIN LEE SEABURN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 BITTER SPRINGS DR
FORT IRWIN CA
92310-1598
US

IV. Provider business mailing address

3935 BITTER SPRINGS DR
FORT IRWIN CA
92310-1598
US

V. Phone/Fax

Practice location:
  • Phone: 417-827-1328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License Number1103315
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: