Provider Demographics
NPI:1871776732
Name:AMADOR, JAVIER D (MD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:D
Last Name:AMADOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:484 SW COMMERCE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1588
Mailing Address - Country:US
Mailing Address - Phone:386-754-3000
Mailing Address - Fax:352-384-8104
Practice Address - Street 1:484 SW COMMERCE DR STE 140
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1588
Practice Address - Country:US
Practice Address - Phone:386-754-3000
Practice Address - Fax:352-384-8104
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN751207Q00000X
PR16934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine