Healthcare Provider Details

I. General information

NPI: 1982627576
Provider Name (Legal Business Name): JOHN ROGER CHAVES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W ALAMEDA AVE SUITE 312
BURBANK CA
91505-4800
US

IV. Provider business mailing address

PO BOX 7001
TARZANA CA
91357-7001
US

V. Phone/Fax

Practice location:
  • Phone: 818-842-9728
  • Fax: 818-842-8273
Mailing address:
  • Phone: 818-888-7815
  • Fax: 818-715-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG31984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: