Provider Demographics
NPI:1811969306
Name:LAVAN, JOSEPH TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:TIMOTHY
Last Name:LAVAN
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 1:1902 ORCHARD GLEN CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-4785
Mailing Address - Country:US
Mailing Address - Phone:850-380-3392
Mailing Address - Fax:
Practice Address - Street 1:2101 NASA PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3696
Practice Address - Country:US
Practice Address - Phone:281-244-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME153366207Q00000X, 2083X0100X
WAMD00045023207Q00000X
TXT7275207Q00000X, 2083X0100X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine