Healthcare Provider Details

I. General information

NPI: 1629066691
Provider Name (Legal Business Name): JAVIER LORENZO TAPIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 L V STABLER DR
GREENVILLE AL
36037-3865
US

IV. Provider business mailing address

46 L V STABLER DR
GREENVILLE AL
36037-3865
US

V. Phone/Fax

Practice location:
  • Phone: 334-382-9760
  • Fax: 334-383-9331
Mailing address:
  • Phone: 334-382-9760
  • Fax: 334-383-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00024891
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: