Provider Demographics
NPI:1538154943
Name:BLEICHNER, JAVIER ANGEL (MD)
Entity type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:ANGEL
Last Name:BLEICHNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2595 TAMPA RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3152
Mailing Address - Country:US
Mailing Address - Phone:727-785-7402
Mailing Address - Fax:727-784-7301
Practice Address - Street 1:2595 TAMPA RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3152
Practice Address - Country:US
Practice Address - Phone:727-785-7402
Practice Address - Fax:727-784-7301
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL039485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
62381OtherBS
D21852Medicare UPIN
62381OtherBS