Healthcare Provider Details

I. General information

NPI: 1164465613
Provider Name (Legal Business Name): JERALD DUANE CHAFFIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W US HIGHWAY 60
MOUNTAIN VIEW MO
65548-8542
US

IV. Provider business mailing address

125 STONERIDGE DR
BRANSON MO
65616-3714
US

V. Phone/Fax

Practice location:
  • Phone: 417-934-7090
  • Fax:
Mailing address:
  • Phone: 417-334-1682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR6A25
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: