Provider Demographics
NPI:1083628879
Name:VALADEZ, JAVIER A (MD)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:A
Last Name:VALADEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-5732
Mailing Address - Country:US
Mailing Address - Phone:214-942-3113
Mailing Address - Fax:214-572-6888
Practice Address - Street 1:1922 W 10TH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5732
Practice Address - Country:US
Practice Address - Phone:214-942-3113
Practice Address - Fax:214-572-6888
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123447802Medicaid
TX00L91HMedicare ID - Type Unspecified
TX123447802Medicaid