MEDICARE: LANCE BRYAN DEROSIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1588333876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE BRYAN DEROSIER

Provider Business Mailing Address
First Line	:	PSC 1 BOX 631
Second Line	:
City	:	APO
State	:	AE
Zip	:	09009-0007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N SHORT ST
Second Line	:
City	:	FAIRCHILD AFB
State	:	WA
Zip	:	99011-9530
Country	:	US
Telephone Number	:	425-501-9301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2021
Last Update Date	:	09/09/2021

Similar Medicare Providers

1851036982 — KYLE SCOTT CAMERON DNP, FNP-C
Practice Location Address:

701 HOSPITAL LOOP
FAIRCHILD AFB, WA
99011-8704

Practice Phone: 541-961-3463
Practice Fax:

1063415917 — DR. SCOTT ANDREW MAZANEC DDS
Practice Location Address:

709 HOSPITAL LOOP STE 118
FAIRCHILD AFB, WA
99011-8705

Practice Phone: 509-465-0995
Practice Fax: 509-247-4140

1518950682 — CAMTU M THAI MD
Practice Location Address:

701 HOSPITAL LOOP
FAIRCHILD AFB, WA
99011-8704

Practice Phone: 509-247-5661
Practice Fax:

1528051521 — RHETT NORRIS
Practice Location Address:

701 HOSPITAL LOOP
FAIRCHILD AFB, WA
99011-8704

Practice Phone: 509-247-5882
Practice Fax:

1174516611 — DR. JOHN F CARGIOLI
Practice Location Address:

701 HOSPITAL LOOP
FAIRCHILD AFB, WA
99011-8704

Practice Phone: 509-247-3032
Practice Fax: 509-247-2021

1134113905 — LEAH W. BROCKWAY MD
Practice Location Address:

92 MEDICAL GROUP/ FLIGHT MEDICINE CLINIC , 700 HOSPITAL LOOP, BLDG 9000
FAIRCHILD AFB, WA
99011

Practice Phone: 509-247-5755
Practice Fax: 509-247-8833

Directions to “ LANCE BRYAN DEROSIER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.