Individual
MR. RANDY SCOTT BREIDEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SUB IDC
Contact information
Practice address
DAM NECK ANNEX, 1885 TERRIER AVE STE 100, VIRGINIA BEACH, VA 23461-2298
(757) 314-7221
Mailing address
761 DWYER RD, VIRGINIA BEACH, VA 23454-6924
(757) 689-8742
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/16/2006
Last updated
07/21/2022
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