Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Bryan Michael Wallace, SOIDC

Individual provider Independent Duty Corpsman · NPI 1336825926

Bryan Michael Wallace, SOIDC is an Independent Duty Corpsman in Camp Lejeune, North Carolina. Registered with an NPI since 2023.

In the registry since
2023

Practice location Address checks out

1ST Marine Raider Battalion Stone Bay
Camp Lejeune, NC 28542
Phone: (910) 440-2504
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Independent Duty Corpsman (primary) Taxonomy 1710I1002X

Record details

NPI number1336825926
Entity typeIndividual (Type 1)
GenderMale
Credentials SOIDC
Sole proprietorNo
NPI enumeratedJune 27, 2023
Last updated in NPPESJune 30, 2023
Certification dateJune 30, 2023

Other providers in Camp Lejeune