MEDICARE: DR. JAVIER SOBRADO 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
1	207RG0100X	Gastroenterology Physician	ME0056369	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689636391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAVIER SOBRADO M.D.

Provider Business Mailing Address
First Line	:	8525 SW 92ND ST
Second Line	:	SUITE D-17
City	:	MIAMI
State	:	FL
Zip	:	33156-7365
Country	:	US
Telephone Number	:	305-270-0402
Fax Number	:	305-595-6179

Provider Business Practice Location Address
First Line	:	8525 SW 92ND ST
Second Line	:	SUITE D-17
City	:	MIAMI
State	:	FL
Zip	:	33156-7365
Country	:	US
Telephone Number	:	305-270-0402
Fax Number	:	305-595-6179

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	02/22/2010

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