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Individual
DR. DAVID FAVREAU FARDON
Active
Individual
DR. DAVID FAVREAU FARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036118859
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036118859
—
IL
01
—
1633878
BCBS
IL
01
—
207067
MEDICARE PTAN LOCALITY 16
IL
01
—
207073
MEDICARE PTAN LOCALITY 15
IL
01
—
4457824
AETNA
—
Enumeration date
03/01/2006
Last updated
11/23/2009
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