MEDICARE: JOHN R BAIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1710I1002X	Independent Duty Corpsman

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1710I1002X	OTHER	VA	INDEPENDENT DUTY CORPSMAN

General Provider Information

NPI Number	:	1912965393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN R BAIR

Provider Business Mailing Address
First Line	:	500 TALDAN CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5523
Country	:	US
Telephone Number	:	757-962-1642
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS (FFG 52)
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09566-1506
Country	:	US
Telephone Number	:	757-445-6510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/21/2022

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