Healthcare Provider Details

I. General information

NPI: 1770566333
Provider Name (Legal Business Name): STEPHEN CHAKMAKJIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W STATE HIGHWAY 6 SUITE 102
WACO TX
76710-5591
US

IV. Provider business mailing address

PO BOX 7655
WACO TX
76714-7655
US

V. Phone/Fax

Practice location:
  • Phone: 254-399-8364
  • Fax: 254-399-9116
Mailing address:
  • Phone: 254-751-9669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL5700
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: