MEDICARE: JESSE R. CHAFFIN 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	207Q00000X	Family Medicine Physician	28275	WV

General Provider Information

NPI Number	:	1386025310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE R. CHAFFIN MD

Provider Business Mailing Address
First Line	:	252 RURAL ACRES DR
Second Line	:
City	:	BECKLEY
State	:	WV
Zip	:	25801-3503
Country	:	US
Telephone Number	:	304-252-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	6633 SHOESTRING TRL
Second Line	:
City	:	WILLIAMSBURG
State	:	WV
Zip	:	24991-3200
Country	:	US
Telephone Number	:	304-645-7872
Fax Number	:

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	12/15/2025

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