Healthcare Provider Details

I. General information

NPI: 1003079773
Provider Name (Legal Business Name): INDERJIT CHABRA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: INDY CHABRA MD, PHD

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 E. CAMP LOWELL DRIVE
TUCSON AZ
85712-1256
US

IV. Provider business mailing address

4715 E. CAMP LOWELL DRIVE
TUCSON AZ
85712-1256
US

V. Phone/Fax

Practice location:
  • Phone: 520-955-8395
  • Fax: 520-300-8013
Mailing address:
  • Phone: 520-433-7000
  • Fax: 520-300-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number8447
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number40345
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number27328
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number59743
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number8447
License Number StateSD
# 6
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number40345
License Number StateIA
# 7
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number27328
License Number StateNE
# 8
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number59743
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: