Healthcare Provider Details

I. General information

NPI: 1861458754
Provider Name (Legal Business Name): PATRICK MICHAEL CHIASSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 N LA CHOLLA BLVD STE 250
TUCSON AZ
85741-3529
US

IV. Provider business mailing address

6230 N LA CHOLLA BLVD STE 250
TUCSON AZ
85741-3529
US

V. Phone/Fax

Practice location:
  • Phone: 520-219-8690
  • Fax: 520-219-8694
Mailing address:
  • Phone: 520-219-8690
  • Fax: 520-219-8694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number29820
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29820
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: