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General NPI Number Information
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NPI Number | 1609447713
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Entity Type | Individual
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Provider Name | JAVON DEONTAY SCOTT-FLETCHER
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Gender | Male
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 16307 MANGO RIDGE CT
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City | HUMBLE
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State | TX
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Zip | 77396-3961
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Country | US
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Telephone | 713-614-1675
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Fax |
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Provider Business Mailing Address
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Address Line | 16307 MANGO RIDGE CT
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City | HUMBLE
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State | TX
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Zip | 77396-3961
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Country | US
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Telephone | 713-614-1675
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BD1200X
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Taxonomy Name | Dialysis Equipment & Supplies (DME)
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License Number | 1712206
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License Number State | TX
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