# DR. DAVID FAVREAU FARDON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1811964679
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036118859 | IL | Yes |

## Other

- **Enumeration date:** 03/01/2006
- **Last updated:** 11/23/2009

## 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 | — |