Individual
MR. JAVIER LICON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2695 HENDERSONVILLE RD, SUITE 204, ARDEN, NC 28704-8576
(828) 687-8647
Mailing address
PO BOX 602373, CHARLOTTE, NC 28260-2373
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
0010-01122
NC
Other
Enumeration date
12/05/2007
Last updated
02/09/2022
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