Provider Demographics
NPI:1962402628
Name:JAVORS, JONATHAN R (DO)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:R
Last Name:JAVORS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W 89TH AVE STE W5
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7050
Mailing Address - Country:US
Mailing Address - Phone:219-662-2279
Mailing Address - Fax:855-742-9438
Practice Address - Street 1:333 W 89TH AVE STE W5
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7050
Practice Address - Country:US
Practice Address - Phone:219-662-2279
Practice Address - Fax:855-742-9438
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001033A207X00000X
IN02001033207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000387160OtherANTHEM
4362881OtherAETNA
IN90001255OtherBLUECROSSBLUESHIELD/ILLIN
IN100366110Medicaid
IN20916250Medicaid
IN499500ZZZZMedicare PIN
IN20916250Medicaid
IN100366110Medicaid
INP00286447Medicare PIN
D94922Medicare UPIN
IN233670AMedicare PIN