Bobby Ray Phillips Jr., IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

3D Marine Raider Battalion, Rr612 Everett Creek Rd
Camp Lejeune, NC 28542-0073

Phone

(910) 440-1947

NPI assigned

May 26, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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": "1653523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1902544042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3D MARINE RAIDER BATTALION, PSC BOX 20073",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285420073",
            "telephone_number": "910-440-1947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3D MARINE RAIDER BATTALION, RR612 EVERETT CREEK RD",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "285420073",
            "telephone_number": "910-440-1947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "BOBBY",
        "middle_name": "RAY",
        "name_suffix": "Jr.",
        "credential": "IDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-26",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bobby.phillips@socom.mil",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3D Marine Raider Battalion, RR612 everett creek RD",
            "city": "Camp Lejeune",
            "state": "NC",
            "country_code": "US",
            "postal_code": "285420073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alex C Pham, DDS
• Dat Duc Pham, PHARMD.
• Serena Phen
• Angela Judge Phillippe, PT
• Alicia Elizabeth Adelman Phillips, DO
• Caitlin Phillips
• Delena Hien Phung, DDS
• Kendall Pick, SOIDC
• Lauren Pierce, LCSW
• Michael Pierce, MD

• Independent Duty Corpsman in Camp Lejeune, NC
• Providers in Camp Lejeune, NC by specialty
• Independent Duty Corpsman in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; 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.