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NPI Code Detail

MEDICARE: DR. STEPHEN JACK CHESTER MD

MEDICARE: DR. STEPHEN JACK CHESTER 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
1208D00000XGeneral Practice Physician341324LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366903569
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN JACK CHESTER MD
Provider Business Mailing Address
First Line : 9322 N MACRUM AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97203-2552
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2890 DOUGLAS DR STE 100
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-5806
Country : US
Telephone Number : 318-742-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2019
Last Update Date : 09/13/2025

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Directions to “ DR. STEPHEN JACK CHESTER MD” Practice Location

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