BRYAN J FUNKE (NPI# 1629055298) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629055298 |
| Entity Type | Individual |
| Full Name | BRYAN J FUNKE |
| Credential | MD, MPH |
| Practice Address |
420 Polifka Dr Bldg 1042 Shaw Afb SC 29152-5100 |
| Practice Telephone | 8038956746 |
| Practice Fax Number | 8038956746 |
| Mailing Telephone | 8038956746 |
| Mailing Fax Number | 8038956746 |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2018-04-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083A0100X |
Preventive Medicine Specialization: Aerospace Medicine |
MD31441 | SC | Allopathic & Osteopathic Physicians |
| N | 2083X0100X |
Preventive Medicine Specialization: Occupational Medicine |
MD31441 | SC | Allopathic & Osteopathic Physicians |
| Street Address |
420 POLIFKA DR BLDG 1042 |
| City | SHAW AFB |
| State | SC |
| Zip Code | 29152-5100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396232518 | Denise D Garvin | Nurse Practitioner | 420 Polifka Dr Bldg 1042, Shaw Afb, SC 29152-5100 | 2018-04-13 |
| 1225530876 | Lukas Maier | Psychologist | 420 Polifka Dr Bldg 1042, Shaw Afb, SC 29152-5100 | 2018-02-28 |
| 1699158154 | David Nguyen | Family Medicine | 420 Polifka Dr Bldg 1042, Shaw Afb, SC 29152 | 2015-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487201695 | Ethan Lee Brockett | Dentist | Shaw Afb Dental Clinic, Shaw Afb, AE 29152 | 2019-08-22 |
| 1275066821 | Travis B Grindstaff | General Acute Care Hospital | 411 Polifka Dr, Shaw Afb, SC 29152 | 2017-04-10 |
| 1851791578 | Terrance Walker | Psychologist | 431 Meadow St, Sumter, SC 29152 | 2014-08-29 |
| 1124258967 | Jacqueline Mintz | Nurse Practitioner | 524 Nelson Ave, Shaw Afb, SC 29152 | 2009-07-14 |
| 1396970117 | Jennifer N Steele | Military Health Care Provider | 411 Meadowlark St, Shaw A F B, SC 29152 | 2009-05-22 |
| 1285899146 | Elizabeth Ann Vandevelde | Nurse Practitioner | 129 North Washington, Tuomey Healthcare System, Sumter, SC 29152 | 2008-07-21 |
| 1134211089 | Kibrom T Mehari | Dentist | 449 Shaw Dr, Shaw A F B, SC 29152 | 2006-09-29 |
| 1134155773 | Theresa Jean Ulichney | Registered Nurse | 420 Polifka Dr, Shaw Afb, SC 29152 | 2006-06-24 |
| 1366415184 | Kimberly Marie Shanks | Nurse Practitioner | 431 Meadowlark Rd, Shaw Afb, SC 29152 | 2006-02-10 |
| 1194710780 | Anthony Shawn Bankes | Family Medicine | 411 Medowlark, Shaw Afb, SC 29152 | 2005-09-20 |
| Find all providers in zip 29152 | ||||
| Taxonomy Code | 2083A0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Aerospace Medicine |
| Aerospace medicine focuses on the clinical care, research, and operational support of the health, safety, and performance of crewmembers and passengers of air and space vehicles, together with the support personnel who assist operation of such vehicles. This population often works and lives in remote, isolated, extreme, or enclosed environments under conditions of physical and psychological stress. Practitioners strive for an optimal human-machine match in occupational settings rich with environmental hazards and engineering countermeasures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. American Osteopathic Board of Preventive Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437594363 | Brian C Wolf | Preventive Medicine | 411 Meadowlark St, Shaw Afb, SC 29152 | 2013-05-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386034627 | Paul Mitchell Bell | Preventive Medicine | 1 Pinckney Blvd, Beaufort, SC 29902-6122 | 2015-01-26 |
| 1316231285 | Scott Aaron Cygan | Preventive Medicine | 2660 Reidville Rd Unit 1, Spartanburg, SC 29301-3512 | 2011-06-07 |
| 1376503516 | James Edwin Boyd | Preventive Medicine | 204 W Hill Blvd, Charleston Afb, SC 29404-4704 | 2006-03-23 |
| 1679559132 | Mark Nicholas Flanagan | Preventive Medicine | 1 Pinckney Blvd, Beaufort, SC 29902-6122 | 2005-12-16 |
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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.