MEDICARE: DR. GARY W. CHESSMAN D.P.M.

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	213E00000X	Podiatrist	PO0002365	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	625224	OTHER	FL	AETNA
2	65313	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710971056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY W. CHESSMAN D.P.M.

Provider Business Mailing Address
First Line	:	7560 RED BUG LAKE ROAD
Second Line	:	SUITE 2024
City	:	OVIEDO
State	:	FL
Zip	:	32765-6504
Country	:	US
Telephone Number	:	407-679-7444
Fax Number	:	407-359-6840

Provider Business Practice Location Address
First Line	:	7560 RED BUG LAKE ROAD
Second Line	:	SUITE 2024
City	:	OVIEDO
State	:	FL
Zip	:	32765-6504
Country	:	US
Telephone Number	:	407-679-7444
Fax Number	:	407-359-6840

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	06/18/2013

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