Provider Demographics
NPI:1215629100
Name:FAVORITE, JB JAMES
Entity type:Individual
Prefix:
First Name:JB
Middle Name:JAMES
Last Name:FAVORITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 APPALACHIAN CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1620
Mailing Address - Country:US
Mailing Address - Phone:843-231-9865
Mailing Address - Fax:
Practice Address - Street 1:604 APPALACHIAN CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1620
Practice Address - Country:US
Practice Address - Phone:843-231-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2081S0010X2083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports MedicineGroup - Single Specialty