Provider Demographics
NPI:1609447713
Name:SCOTT-FLETCHER, JAVON DEONTAY
Entity Type:Individual
Prefix:
First Name:JAVON
Middle Name:DEONTAY
Last Name:SCOTT-FLETCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16307 MANGO RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-3961
Mailing Address - Country:US
Mailing Address - Phone:713-614-1675
Mailing Address - Fax:
Practice Address - Street 1:16307 MANGO RIDGE CT
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-3961
Practice Address - Country:US
Practice Address - Phone:713-614-1675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1712206332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX41701256OtherMEDICAL UNITS