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General NPI Number Information
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NPI Number | 1366643306
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Entity Type | Individual
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Provider Name | MARIO FERNANDES CHAMMAS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 777 BANNOCK ST
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City | DENVER
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State | CO
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Zip | 80204-4507
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Country | US
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Telephone | 303-436-6563
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Fax | 303-436-6572
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Provider Business Mailing Address
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Address Line | 77 S OGDEN ST APT 221
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City | DENVER
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State | CO
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Zip | 80209-2346
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Country | US
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Telephone | 303-921-7246
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Fax | 303-436-6572
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 45581
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License Number State | CO
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