Healthcare Provider Details

I. General information

NPI: 1124110275
Provider Name (Legal Business Name): DAVID R CHAVEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DR
LEBANON NH
03756-0001
US

IV. Provider business mailing address

ONE MEDICAL CENTER DR
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-9882
  • Fax: 603-653-0908
Mailing address:
  • Phone: 603-653-9882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number8217
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number6858A
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number15955
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number15955
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: