Healthcare Provider Details

I. General information

NPI: 1114572757
Provider Name (Legal Business Name): HENRI D CHAPERON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5918 APPALOOSA WAY
ORLANDO FL
32822-4213
US

IV. Provider business mailing address

5918 APPALOOSA WAY
ORLANDO FL
32822-4213
US

V. Phone/Fax

Practice location:
  • Phone: 678-832-5736
  • Fax:
Mailing address:
  • Phone: 678-832-5736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000340-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: