Healthcare Provider Details

I. General information

NPI: 1346231966
Provider Name (Legal Business Name): JOHN ROY CHEWNING DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 HAND AVE, SUITE L
ORMOND BEACH FL
32174
US

IV. Provider business mailing address

1425 HAND AVE, SUITE L
ORMOND BEACH FL
32174
US

V. Phone/Fax

Practice location:
  • Phone: 386-256-3977
  • Fax: 386-872-5004
Mailing address:
  • Phone: 386-256-3977
  • Fax: 386-872-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: