Provider Demographics
NPI:1093878258
Name:JAVDAN, RON (MD)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:JAVDAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 JUNGERMANN CIR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1621
Mailing Address - Country:US
Mailing Address - Phone:636-928-1822
Mailing Address - Fax:636-441-7033
Practice Address - Street 1:3631 CRENSHAW BLVD STE 109
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4869
Practice Address - Country:US
Practice Address - Phone:323-732-0100
Practice Address - Fax:323-732-0104
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR8435207RC0000X
CAC50454207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease