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NPI Code Detail

MEDICARE: AMARIS NAVEDO M.D.

MEDICARE: AMARIS NAVEDO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician14431PR

General Provider Information

NPI Number : 1225258122
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMARIS NAVEDO M.D.
Provider Business Mailing Address
First Line : 3353 UNIVERSITY PKWY
Second Line : FORT POLK VA COMMUNITY BASED OUTPATIENT CLINIC
City : LEESVILLE
State : LA
Zip : 71446-9041
Country : US
Telephone Number : 337-392-3800
Fax Number : 337-392-3890
Provider Business Practice Location Address
First Line : 3353 UNIVERSITY PKWY
Second Line : FORT POLK VA COMMUNITY BASED OUTPATIENT CLINIC
City : LEESVILLE
State : LA
Zip : 71446-9041
Country : US
Telephone Number : 337-392-3800
Fax Number : 337-392-3890
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2007
Last Update Date : 03/15/2016

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