Healthcare Provider Details

I. General information

NPI: 1083294409
Provider Name (Legal Business Name): JASON VICTOR CHAVEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

804 WHITTINGTON TER
SILVER SPRING MD
20901-1056
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-5511
  • Fax:
Mailing address:
  • Phone: 301-580-7686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0097055
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: