Provider Demographics
NPI:1285884841
Name:NAVARRETE FAUBLA, JAIME IGNACIO (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:IGNACIO
Last Name:NAVARRETE FAUBLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 ELMWOOD AVE BOX MED
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5863
Mailing Address - Fax:585-273-5761
Practice Address - Street 1:1400 PIN OAK DR
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918
Practice Address - Country:US
Practice Address - Phone:618-985-3333
Practice Address - Fax:618-985-1318
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY258375207RH0000X, 208M00000X, 207RH0003X
IL036.144721207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03357820Medicaid
NYJ400063559Medicare PIN
NY03357820Medicaid
NY10712AMedicare PIN
NY70005AMedicare PIN