Lance Bryan Derosier

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

300 N Short St
Fairchild Afb, WA 99011-9530

Phone

(425) 501-9301

NPI assigned

Sep 9, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1588333876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "PSC 1 BOX 631",
            "city": "APO",
            "state": "AE",
            "postal_code": "090090007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N SHORT ST",
            "city": "FAIRCHILD AFB",
            "state": "WA",
            "postal_code": "990119530",
            "telephone_number": "425-501-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROSIER",
        "first_name": "LANCE",
        "middle_name": "BRYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Collins, RN
• Mariah Combs
• Andrew Coutermarsh, DO
• Samantha Crucet, IDMT
• Stephanie M Davis, M.D.
• Darrian Dewald, LMFTA
• Brian Diiorio, DPT
• Nathan James Dillow, IDMT
• Jenna Leigh Doyle, PA
• Dillon Duvall, PT

• Independent Duty Medical Technicians in Fairchild Afb, WA
• Providers in Fairchild Afb, WA by specialty
• Independent Duty Medical Technicians in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.