DR. BRENT DALEE LIBBY (NPI# 1821078346) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821078346 |
| Entity Type | Individual |
| Full Name | DR. BRENT DALEE LIBBY |
| Credential | MD |
| Practice Address |
Attn: Medical Staff Services Bldg. H 2005 Knight Lane Navy Medicine Support Command Jacksonville FL 32212-0140 |
| Mailing Address |
7 Pleasant Place Ct Beaufort SC 29907-1187 |
| Practice Telephone | 9045427200 |
| Mailing Telephone | 8435240743 |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2010-02-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
0101232281 | VA | Allopathic & Osteopathic Physicians |
| Street Address |
ATTN: MEDICAL STAFF SERVICES BLDG. H 2005 KNIGHT LANE NAVY MEDICINE SUPPORT COMMAND |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32212-0140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952911752 | Jeff Woohyeok Chang | Dentist | 964 Ajax Street, Jacksonville, FL 32212 | 2020-08-06 |
| 1518484427 | Amy Kathryn Lee | Student in an Organized Health Care Education/Training Program | Bumed, Centralized Credential & Privileging Directorate, 554 Keily Street, Jacksonville, FL 32212 | 2017-08-23 |
| 1659827970 | Noah Fixelle | Dentist | Bureau of Med and Surg Ccpd, 554 Keily Street, Jacksonville, VA 32212 | 2016-08-28 |
| 1972953339 | Colin Kenneth Kelly | General Practice | Bureau of Medicine & Surgery Detachment, Nas Jacksonville, Building 554, Jacksonville, FL 32212 | 2016-06-16 |
| 1912382359 | Caitlyn Brooke Hoysock | Dentist | 554 Keiley Street, Bureau of Medicine and Surgery - Credentials, Jacksonville, FL 32212 | 2015-07-28 |
| 1285017418 | John Alexander Ruch | Dentist | 554 Keily Street Bureau of Med and Surg Ccpd, Jacksonville, FL 32212 | 2015-07-07 |
| 1407238561 | Amanda Mona Lau | Student in an Organized Health Care Education/Training Program | 554 Kelly Street, Attn Centralized Credentialing, Bureau of Medicine and Surgery, Jacksonville, FL 32212 | 2015-06-25 |
| 1063894715 | Heather Dehaan | Family Medicine | 554 Kelly Street Bureau of Medicine and Surgery, Attention: Centralized Credentialing & Privileging Dire, Jacksonville, FL 32212 | 2015-06-18 |
| 1912389677 | Catherine Garcia | Student in an Organized Health Care Education/Training Program | 554 Kelly St, Credentialing & Privileging Directorate, Bureau of Medicine & Surgery, Attention: Centralized, Jacksonville, FL 32212 | 2015-06-18 |
| 1255712675 | James Robert Benson | Dentist | 734 Keily Street, Bumed, Jacksonville, FL 32212 | 2015-06-11 |
| Find all providers in zip 32212 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| 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 Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316596471 | Summerlin Imaging Center LLC | Radiology | 3550 University Blvd S Ste 102, Jacksonville, FL 32216-4227 | 2019-09-10 |
| 1275038671 | William Austin Forshee | Radiology | 655 W 8th St Fl 2, Jacksonville, FL 32209-6511 | 2018-03-27 |
| 1316449267 | F&s Radiology, P.C. | Radiology | 10045 Richton Ct, Jacksonville, FL 32246-1885 | 2018-03-07 |
| 1679025522 | Diagnostic Imaging Partners | Radiology | 2000 Brabham Avenue, Suite 110, Jacksonville, NC 28546 | 2016-10-26 |
| 1689052359 | Coastal Vein & Vascular Institute, LLC | Radiology | 7741 Point Meadows Dr, Unit 104-106, Jacksonville, FL 32256-9182 | 2015-05-13 |
| 1316385024 | Matthew Hal Jenson | Radiology | 655 W 8th St # C-90, Jacksonville, FL 32209-6511 | 2013-06-05 |
| 1740557917 | Rmed LLC | Radiology | 4348 Southpoint Blvd., Suite 100c, Jacksonville, FL 32216-0903 | 2011-11-16 |
| 1952618324 | Edgardo Alberto Agrait-bertran | Radiology | 12743 Ellis Island Dr, Jacksonville, FL 32224-8512 | 2010-09-08 |
| 1477788982 | David A Walker Md Pa | Radiology | 8040 Woodpecker Trl, Jacksonville, FL 32256-7333 | 2009-05-28 |
| 1245465343 | Kyle Hayden | Radiology | 1303 Greenridge Rd, Jacksonville, FL 32207-5334 | 2009-05-19 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32212 |
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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.