Provider Demographics
NPI:1124262746
Name:BRIGHT, JOHN CRAIG (IDMT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CRAIG
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3062 VAESSEN CT
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3672
Mailing Address - Country:US
Mailing Address - Phone:808-291-3747
Mailing Address - Fax:
Practice Address - Street 1:15MDOS/SGOMF 755 SCOTT CIRCLE
Practice Address - Street 2:
Practice Address - City:HICKAM AFB
Practice Address - State:HI
Practice Address - Zip Code:96853-3672
Practice Address - Country:US
Practice Address - Phone:808-448-6729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians