NPI Profile for JB J FAVORITE in CHESAPEAKE, VA.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Sports Medicine |
2083S0010X | 84 | Physician/Preventive Medicine |
| NPI # | 1215629100 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 05/22/2023 | |
| Last updated | 05/22/2023 - About 3 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
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|
| Hospital affiliation(s) | Not Available |
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JB J FAVORITE
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