Provider Demographics
NPI:1346017936
Name:BEAR, JOHN DAVID I
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:BEAR
Suffix:I
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 1:1004 CARLISLE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1615
Mailing Address - Country:US
Mailing Address - Phone:303-667-3708
Mailing Address - Fax:
Practice Address - Street 1:1004 CARLISLE BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1615
Practice Address - Country:US
Practice Address - Phone:303-667-3708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician