Provider Demographics
NPI:1003819624
Name:JAVIER, FELIPE COSCOLLUELA III (MD)
Entity Type:Individual
Prefix:
First Name:FELIPE
Middle Name:COSCOLLUELA
Last Name:JAVIER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 SAINT FRANCIS DR STE 411
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5634
Mailing Address - Country:US
Mailing Address - Phone:319-272-5000
Mailing Address - Fax:319-272-5825
Practice Address - Street 1:2710 SAINT FRANCIS DR STE 411
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5634
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:319-272-5825
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-100466207K00000X, 208000000X
IA32545208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAO278374Medicaid
MO203896410Medicaid
421527584OtherTRI-CARE GROUP NUMBER
33628OtherBLUE CROSS BLUE SHIELD
IL421527584003Medicaid
42152758408OtherJOHN DEERE
33628OtherBLUE CROSS BLUE SHIELD
421527584OtherTRI-CARE GROUP NUMBER
IAO278374Medicaid