Provider Demographics
NPI:1588755813
Name:DOMINGO G JAVIER MD INC
Entity type:Organization
Organization Name:DOMINGO G JAVIER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:GONZALES
Authorized Official - Last Name:JAVIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-325-5755
Mailing Address - Street 1:1701 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1701
Mailing Address - Country:US
Mailing Address - Phone:304-325-5755
Mailing Address - Fax:304-323-1639
Practice Address - Street 1:1701 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-1701
Practice Address - Country:US
Practice Address - Phone:304-325-5755
Practice Address - Fax:304-323-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0472131OtherUMWA-FUNDS
WV0127512000Medicaid
VA7350431OtherVA MED ASSIS
V000267OtherBLACK LUNG
VA062480OtherB/C/ANTHEM
851 945OtherMAMSI
WV1022384OtherWORKERS COMP
4454937OtherAETNA
VA7350431OtherVA MED ASSIS
4454937OtherAETNA