Healthcare Provider Details

I. General information

NPI: 1164988713
Provider Name (Legal Business Name): JOHN BERNARD FAVORITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL OKINAWA FUTENMA
GINOWAN OKINAWA
9012202
JP

IV. Provider business mailing address

PSC 482 BOX 205
FPO AP
96362-0003
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101270946
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: