Provider Demographics
NPI:1881754042
Name:REPETTO, JAVIER E (MD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:E
Last Name:REPETTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10250 LAKE SIDE DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-5007
Mailing Address - Country:US
Mailing Address - Phone:205-333-4656
Mailing Address - Fax:205-333-4660
Practice Address - Street 1:809 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2029
Practice Address - Country:US
Practice Address - Phone:205-333-4656
Practice Address - Fax:205-333-4660
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2015-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL227082080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009956880Medicaid
AL051502661OtherBLUE CROSS/BLUE SHIELD OF AL - NORTHPORT
AL051522241OtherBLUE CROSS/BLUE SHIELD OF AL - DCH
AL051522241OtherBLUE CROSS/BLUE SHIELD OF AL - DCH