Basic Information
| Provider Information | |||||||||
| NPI: | 1861481368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAVAS | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | PEDRO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NAVAS DACOSTA | ||||||||
| OtherFirstName: | JORGE | ||||||||
| OtherMiddleName: | PEDRO | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 455 PINELLAS ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274451911 | ||||||||
| FaxNumber: | 7274451986 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 PINELLAS ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337563356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274451911 | ||||||||
| FaxNumber: | 7274451986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 10/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME65300 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 375186400 | 05 | FL | MEDICAID |