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Individual
JOHN DEFOREST
Active
Individual
JOHN DEFOREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
336051704
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036089998
—
IL
01
—
080154175
RAILROAD MEDICARE
—
01
—
9925692
BC/BS
IL
Enumeration date
06/23/2006
Last updated
12/09/2014
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