Healthcare Provider Details

I. General information

NPI: 1285642603
Provider Name (Legal Business Name): MICHAEL HOOD CHAMALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15010 SLIDE DR
LUBBOCK TX
79424
US

IV. Provider business mailing address

15010 FM 1730
LUBBOCK TX
79424-6635
US

V. Phone/Fax

Practice location:
  • Phone: 806-872-4179
  • Fax:
Mailing address:
  • Phone: 806-863-4206
  • Fax: 806-863-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-2504
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberE2504
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberE2504
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: