Provider Demographics
NPI:1679801401
Name:INFANTE, JOHN ACIDO (HMC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ACIDO
Last Name:INFANTE
Suffix:
Gender:M
Credentials:HMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS BOISE
Mailing Address - Street 2:SSN 764
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09564
Mailing Address - Country:US
Mailing Address - Phone:757-444-4116
Mailing Address - Fax:
Practice Address - Street 1:USS BOISE
Practice Address - Street 2:SSN 764
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09564
Practice Address - Country:US
Practice Address - Phone:757-444-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman