Provider Demographics
NPI:1306090998
Name:JAVDAN, GOSHTASB (MD)
Entity type:Individual
Prefix:DR
First Name:GOSHTASB
Middle Name:
Last Name:JAVDAN
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 1:950 E. VAN BUREN STREET
Mailing Address - Street 2:AVONDALE FAMILY HEALTH CENTER
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323
Mailing Address - Country:US
Mailing Address - Phone:623-344-6800
Mailing Address - Fax:623-344-6801
Practice Address - Street 1:950 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1506
Practice Address - Country:US
Practice Address - Phone:623-344-6800
Practice Address - Fax:623-344-6801
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine