Provider Demographics
NPI:1386694305
Name:GASCOT, JAVIER
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:GASCOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 3296
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9413
Mailing Address - Country:US
Mailing Address - Phone:787-390-5533
Mailing Address - Fax:
Practice Address - Street 1:RR 4 BOX 3296
Practice Address - Street 2:CARR 830 LAS GUABAS, CERRO GORDO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9413
Practice Address - Country:US
Practice Address - Phone:787-390-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15518208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHW857AOtherMEDICATE PTAN
PR0022682Medicare ID - Type Unspecified