Provider Demographics
NPI:1396774584
Name:CANASI, JAVIER J (MD)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:J
Last Name:CANASI
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 1:900 VILLAGE SQUARE XING
Mailing Address - Street 2:STE 130
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4547
Mailing Address - Country:US
Mailing Address - Phone:561-775-0335
Mailing Address - Fax:561-775-9492
Practice Address - Street 1:900 VILLAGE SQUARE XING STE 130
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4547
Practice Address - Country:US
Practice Address - Phone:561-775-0335
Practice Address - Fax:561-775-9492
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277578600Medicaid
FL10876OtherBLUE CROSS BLUE SHIELD
FL1396774584Medicaid
GAP00155039OtherRAILROAD MEDICARE AUG GA
FL10876OtherBLUE CROSS BLUE SHIELD
FL10876UMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL277578600Medicaid