Provider Demographics
NPI:1194764399
Name:PARRA, JAVIER LEONARDO (MD)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:LEONARDO
Last Name:PARRA
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 1:7500 SW 87TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5426
Mailing Address - Country:US
Mailing Address - Phone:305-913-0666
Mailing Address - Fax:305-913-0663
Practice Address - Street 1:7500 SW 87TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5426
Practice Address - Country:US
Practice Address - Phone:305-913-0666
Practice Address - Fax:305-913-0663
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0094654207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI52076Medicare UPIN
FLU7382AMedicare ID - Type Unspecified