Healthcare Provider Details

I. General information

NPI: 1194706267
Provider Name (Legal Business Name): JANETTE LORENA S JAVIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANETTE LORENA S. JAVIER MD

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 03/22/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CHURCH ST
SPRINGFIELD CO
81073-1636
US

IV. Provider business mailing address

373 E 10TH AVE
SPRINGFIELD CO
81073-1699
US

V. Phone/Fax

Practice location:
  • Phone: 719-523-6628
  • Fax: 719-523-4290
Mailing address:
  • Phone: 719-523-4501
  • Fax: 719-523-4290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42267
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: