Provider Demographics
NPI:1578824256
Name:RON JAVDAN MD LLC
Entity type:Organization
Organization Name:RON JAVDAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-434-1399
Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:SUITE 580
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3451
Mailing Address - Country:US
Mailing Address - Phone:314-434-1399
Mailing Address - Fax:314-434-0271
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:SUITE 580
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3451
Practice Address - Country:US
Practice Address - Phone:314-434-1399
Practice Address - Fax:314-434-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA26005Medicare UPIN