Provider Demographics
NPI:1760400725
Name:JAVECH, NESTOR JOAQUIN (MD)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:JOAQUIN
Last Name:JAVECH
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:PO BOX 3123
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3123
Mailing Address - Country:US
Mailing Address - Phone:904-824-4990
Mailing Address - Fax:904-824-2226
Practice Address - Street 1:815 NW 57TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2041
Practice Address - Country:US
Practice Address - Phone:305-904-8988
Practice Address - Fax:305-615-1651
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41274207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD28027Medicare UPIN
FL96840Medicare ID - Type Unspecified