Healthcare Provider Details

I. General information

NPI: 1073892238
Provider Name (Legal Business Name): VALERIE MAXINE CHAVEZ M. D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15808 RANCH ROAD 620 N SUITE 100
AUSTIN TX
78717-4923
US

IV. Provider business mailing address

15808 RANCH ROAD 620 N SUITE 100
AUSTIN TX
78717-4923
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-3554
  • Fax: 512-244-2942
Mailing address:
  • Phone: 512-244-3554
  • Fax: 512-244-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM3497
License Number StateTX

VIII. Authorized Official

Name: VALERIE MAXINE CHAVEZ
Title or Position: MD PA
Credential:
Phone: 512-244-3554