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General NPI Number Information
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NPI Number | 1033109269
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Entity Type | Individual
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Provider Name | BENJAMIN CHACKO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3851 ROGER BROOKE DR BROOKE ARMY MEDICAL CENTER. MCHE-QD/ CREDENTIALS
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4501
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Country | US
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Telephone | 210-916-1245
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Fax |
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Provider Business Mailing Address
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Address Line | 11 MYRTLEWOOD
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City | SAN ANTONIO
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State | TX
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Zip | 78218-6000
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Country | US
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Telephone | 210-822-3087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA04730600
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License Number State | NJ
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