Provider Demographics
NPI:1760668842
Name:JAVIER WAKSMAN MD,PC.
Entity Type:Organization
Organization Name:JAVIER WAKSMAN MD,PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-493-7000
Mailing Address - Street 1:13611 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-5701
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:303-316-7942
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:303-316-7942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39764174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76473279Medicaid
COH60611Medicare PIN
CO524508Medicare PIN