Provider Demographics
NPI:1922094036
Name:JAVAID, FARRUKH (MD)
Entity Type:Individual
Prefix:
First Name:FARRUKH
Middle Name:
Last Name:JAVAID
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 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-2417
Mailing Address - Fax:970-490-4173
Practice Address - Street 1:175 S UNION BLVD STE 350
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3146
Practice Address - Country:US
Practice Address - Phone:719-633-5515
Practice Address - Fax:719-365-1307
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045718207R00000X
WY7765A207R00000X
CODR.0069807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8464950Medicaid
WAMD00045718OtherWA STATE MEDICAL LICENSE
NV8020OtherSTATE MEDICAL LICENSE
WAG48378Medicare UPIN
WA8860001Medicare ID - Type Unspecified
NV8020OtherSTATE MEDICAL LICENSE
WYG48378Medicare UPIN