Healthcare Provider Details

I. General information

NPI: 1558109348
Provider Name (Legal Business Name): BOANERGE ANTONIO OJEDA CHAVARRIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 HOSPITAL DR STE 402
FAIRHOPE AL
36532-2018
US

IV. Provider business mailing address

188 HOSPITAL DR STE 402
FAIRHOPE AL
36532-2018
US

V. Phone/Fax

Practice location:
  • Phone: 251-279-1245
  • Fax:
Mailing address:
  • Phone: 251-279-1245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55094
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number55094
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: