Provider Demographics
NPI:1629066691
Name:TAPIA, JAVIER LORENZO (MD)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:LORENZO
Last Name:TAPIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 L V STABLER DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36037-3865
Mailing Address - Country:US
Mailing Address - Phone:334-382-9760
Mailing Address - Fax:334-383-9331
Practice Address - Street 1:46 L V STABLER DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3865
Practice Address - Country:US
Practice Address - Phone:334-382-9760
Practice Address - Fax:334-383-9331
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00024891208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL541390503Medicaid
AL051520896OtherBLUE CROSS
AL541390503Medicaid