MEDICARE: MICHAEL W CHANCELLOR 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	2085R0001X	Radiation Oncology Physician	ME47961	FL

General Provider Information

NPI Number	:	1790893782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL W CHANCELLOR MD

Provider Business Mailing Address
First Line	:	3425 S ATLANTIC AVE APT 906
Second Line	:
City	:	DAYTONA BEACH SHORES
State	:	FL
Zip	:	32118-6363
Country	:	US
Telephone Number	:	352-561-6357
Fax Number	:	386-666-6258

Provider Business Practice Location Address
First Line	:	3425 S ATLANTIC AVE APT 906
Second Line	:
City	:	DAYTONA BEACH SHORES
State	:	FL
Zip	:	32118-6363
Country	:	US
Telephone Number	:	352-561-6357
Fax Number	:	386-666-6258

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	09/24/2024

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