Provider Demographics
NPI:1518938497
Name:CANON, JAVIER RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:RICARDO
Last Name:CANON
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 1:4911 SANDHILL DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5320
Mailing Address - Country:US
Mailing Address - Phone:281-238-7870
Mailing Address - Fax:
Practice Address - Street 1:22001 SOUTHWEST FWY STE 300
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-7001
Practice Address - Country:US
Practice Address - Phone:281-633-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL85732084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178853101Medicaid
TX178853102Medicaid
TX178853103Medicaid
TX178853104Medicaid
TXP01026725OtherRAILROAD MEDICARE
TX178853105Medicaid
TXTXB143871Medicare PIN
TX8D8060Medicare PIN
TX178853104Medicaid
TX178853103Medicaid
TX178853105Medicaid
TXTXB143873Medicare PIN