Provider Demographics
NPI:1235123605
Name:IQBAL, JAVED (MD)
Entity Type:Individual
Prefix:
First Name:JAVED
Middle Name:
Last Name:IQBAL
Suffix:
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 1:3855 FOOTHILLS RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4620
Mailing Address - Country:US
Mailing Address - Phone:575-532-8561
Mailing Address - Fax:575-532-8567
Practice Address - Street 1:3855 FOOTHILLS RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4620
Practice Address - Country:US
Practice Address - Phone:575-532-8561
Practice Address - Fax:575-532-8567
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK24992084N0400X
NM922562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMF0584Medicaid
F53912Medicare UPIN