MEDICARE: BRYAN R CHAVEZ GARCIA PA-C

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	363AM0700X	Medical Physician Assistant	7625	AZ
2	363A00000X	Physician Assistant	7625	AZ

General Provider Information

NPI Number	:	1942762000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN R CHAVEZ GARCIA PA-C

Provider Business Mailing Address
First Line	:	650 E INDIAN SCHOOL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1839
Country	:	US
Telephone Number	:	623-251-2884
Fax Number	:

Provider Business Practice Location Address
First Line	:	13985 W GRAND AVE STE 101
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-3626
Country	:	US
Telephone Number	:	623-251-2884
Fax Number	:

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

Provider Enumeration Date	:	04/05/2019
Last Update Date	:	07/16/2024

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