Taxonomy Code 1710I1002X(1710i1002x)
Independent Duty Corpsman. Providers: 157

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Independent Duty Corpsman Providers

NPI Name Type Address

1679132112

IDC Hector Salvador Gonzalez

Individual

2 Bushnell St

Groton, CT

1376194274

SUBMARINE IDC Christopher Lee Roy Smith

Individual

Uss San Juan (ssn 751)

Groton, CT

1982244737

SUBMARINE IDC Lonnie Jay Reardon

Individual

55 South Rd Apt 12c

Groton, CT

1063052819

MR. IDC Kenny Daniel Harp

Individual

59 Deerwood Dr

Groton, CT

1609416189

IDC Russell Jennings Rider

Individual

159 Trout Ave

Groton, CT

1477564870

U.s. Navy

Organization

Box 159 Navsubasenlon

Naval Undersea Medical Institute

Groton, CT

1528644960

SUBMARINE IDC Daniel Rene Villela

Individual

166 Arrowood Dr

Groton, CT

1659047827

David Nathaniel Taylor

Individual

60 Mansfield Rd Apt 320

New London, CT

1558010280

SUBMARINE IDC Christopher David Burley

Individual

1 Wahoo Ave

Groton, CT

1841932662

MR. IDC Damian Joel Aguilar

Individual

43 Granite St Apt C6

New London, CT

1750025193

MILITARY (IDC) Jared F Hart

Individual

Submarine Readiness Squadron 32

Building 87 Naval Submarine Base New London

Groton, CT

1619603644

MR. Bradford W Vogel II

Individual

60 Buckeye Rd

Groton, CT

1780310714

MR. Christian L Flowers

Individual

87 Michael Rd Apt E

New London, CT

1023744059

Michael Burton

Individual

84 Charter Oak Dr

Groton, CT

1508593393

MR. John William Vandal

Individual

68 Burningtree Dr

Groton, CT

1174250294

IDC Luis Riverabarrera

Individual

159 Trout Ave

Groton, CT

1760119887

IDC Derek Calloway

Individual

159 Trout Ave

Groton, CT

How to obtain, renew, or terminate an NPI

Every health care provider, whether it’s a hospital, pharmacy, or individual specialist, must obtain their own NPI number. This identification number is unique and is assigned upon application. In tod...

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Taxonomy Code 1710I1002X
Specialization Independent Duty Corpsman
Display Name Independent Duty Corpsman
Taxonomy Group Other Service Providers
Taxonomy Classification Military Health Care Provider
Definition A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.
Effective Date September 30, 2009
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Military Health Care Provider Codes

Independent Duty Medical Technicians

1710I1003X • providers: 1,299

Military Health Care Provider

171000000X • providers: 1,689