LUCAS VANDERMYDE (NPI# 1164083523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164083523 |
| Entity Type | Individual |
| Full Name | LUCAS VANDERMYDE |
| Credential | DO |
| Practice Address |
David Grant Medical Center 101 Bodin Circle Fairfield CA 94535 |
| Mailing Address |
2376 Fairfield Ave Apt 27 Fairfield CA 94533-7611 |
| Practice Telephone | 7074233000 |
| Mailing Telephone | 8154833778 |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2019-06-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171000000X | Military Health Care Provider | Other Service Providers |
| Street Address |
DAVID GRANT MEDICAL CENTER 101 BODIN CIRCLE |
| City | FAIRFIELD |
| State | CA |
| Zip Code | 94535 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013348903 | Lyn Cabigas | Registered Nurse | David Grant Medical Center, Travis Air Force Base, Fairfield, CA 94535 | 2013-12-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508487711 | Sheila C Flood | Student in an Organized Health Care Education/Training Program | 101 Biden Circle, Fairfield, CA 94535 | 2020-04-28 |
| 1568081255 | Miguel Julian Moreno | Student in an Organized Health Care Education/Training Program | 690 Airmen Drive, Travis Afb, CA 94535 | 2020-04-13 |
| 1174096101 | Zlatoslava Karga | Nurse Practitioner | 60mdg / Sgow, 101 Bodin Circle, Travis Afb, CA 94535 | 2019-01-02 |
| 1437648292 | Luke C Vera | Dentist | David Grant Medical Center 101 Bodin Circle, Travis Air Force Base, CA 94535 | 2018-05-08 |
| 1588163430 | Sanaz Ziad | Pharmacist | 60mdg/mdts, 101 Bodin Circle, Travis Afb, CA 94535 | 2018-02-06 |
| 1194265686 | Geoffrey Johnston | Dentist | 60 Mdg/sgdd, 101 Bodin Circle, Travis Afb, CA 94535 | 2017-03-02 |
| 1336693407 | Hannah Isla Nordwall | Social Worker | 60 Mdg/mdos 101 Bodin Cir, Travis Afb, CA 94535 | 2016-08-06 |
| 1184177149 | Taylor Murrie-robinson | Social Worker | 60mdg / Sgow Mental Health Clinic, 101 Bodin Circle, Travis Afb, CA 94535 | 2016-07-26 |
| 1952759607 | Eric Kincaid-sharp | General Practice | 60 Mdg/amds, 101 Bodin Cir, Travis Afb, CA 94535 | 2016-06-02 |
| 1023472040 | Genieve Marie Martinez-hernandez | Internal Medicine | 60 Mdg/sgomi, 101 Bodin Circle, Fairfield, CA 94535 | 2016-04-06 |
| Find all providers in zip 94535 | ||||
| Taxonomy Code | 171000000X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |
| Notes: [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851919468 | Derek P Brady | Military Health Care Provider | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2020-07-09 |
| 1245896968 | Carolyn Alyce Jiang | Military Health Care Provider | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2019-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730755 | Zaccary Griffin | Military Health Care Provider | Building 4101 Stuart Mesa Rd, Camp Pendleton, CA 92055 | 2020-11-02 |
| 1629692389 | Christopher Matey | Military Health Care Provider | 34800 Bob Wilson Dr Ste 110, San Diego, CA 92134-1110 | 2020-05-29 |
| 1982225769 | Jin Ah Kim | Military Health Care Provider | Naval Medical Center San Diego 38400 Bon Wilson Drive, San Diego, CA 92134-5000 | 2020-05-03 |
| 1124647680 | Katherine Koliadko | Military Health Care Provider | 11023 Evans St, Loma Linda, CA 92354-2708 | 2020-04-14 |
| 1508495201 | Benjamin Michael Taylor | Military Health Care Provider | Naval Medical Center San Diego Psychiatry Residency Pgm, 34800 Bob Wilson Drive, San Diego, CA 92134 | 2020-04-04 |
| 1588292858 | Korina Erin Sandoval | Military Health Care Provider | Naval Medical Center Drive 38400 Bob Wilson Dr, San Diego, CA 92134-5000 | 2020-03-31 |
| 1033746508 | Hannah Johnson | Military Health Care Provider | 34800 Bob Wilson Dr Ste 403, San Diego, CA 92134-1403 | 2020-03-25 |
| 1891336541 | Prana Hands Nonprofit | Military Health Care Provider | 2180 Garnet Ave Ste 3l, San Diego, CA 92109-3676 | 2019-10-03 |
| 1578124194 | David M Allen | Military Health Care Provider | 1st Mlg, Bldg 150121, Camp Pendleton, CA 92055 | 2019-06-25 |
| 1992366587 | Darion Pegues | Military Health Care Provider | 3530 Kelsey St, San Diego, CA 92124-3516 | 2019-06-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.