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1023084464

NPI Code Detail

MEDICARE: CHUCK STEPHEN MANGUBAT MD

MEDICARE: CHUCK STEPHEN MANGUBAT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	24330	AZ
2	208M00000X	Hospitalist Physician	24330	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110237007	OTHER	AZ	MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023084464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUCK STEPHEN MANGUBAT MD

Provider Business Mailing Address
First Line	:	3115 S PRICE RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-3544
Country	:	US
Telephone Number	:	480-926-0170
Fax Number	:	602-765-9513

Provider Business Practice Location Address
First Line	:	3115 S PRICE RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-3544
Country	:	US
Telephone Number	:	480-926-0170
Fax Number	:	480-452-0715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2006
Last Update Date	:	03/22/2016

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Directions to “ CHUCK STEPHEN MANGUBAT MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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