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General NPI Number Information
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NPI Number | 1629066691
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Entity Type | Individual
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Provider Name | JAVIER LORENZO TAPIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 46 L V STABLER DR
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City | GREENVILLE
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State | AL
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Zip | 36037-3865
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Country | US
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Telephone | 334-382-9760
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Fax | 334-383-9331
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Provider Business Mailing Address
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Address Line | 46 L V STABLER DR
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City | GREENVILLE
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State | AL
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Zip | 36037-3865
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Country | US
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Telephone | 334-382-9760
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Fax | 334-383-9331
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 00024891
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License Number State | AL
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