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General NPI Number Information
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NPI Number | 1417028119
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Entity Type | Individual
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Provider Name | DAVID J CHESIRE PHD
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 655 W. 8TH STREET UFJAX - DEPT. OF SURGERY/TRAUMA
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City | JACKSONVILLE
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State | FL
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Zip | 32209
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Country | US
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Telephone | 904-244-6631
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Fax | 904-244-4687
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Provider Business Mailing Address
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Address Line | P.O. BOX 44008 UFJP - PROVIDER ENROLLMENT
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City | JACKSONVILLE
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State | FL
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Zip | 32231
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Country | US
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Telephone | 904-244-3199
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Fax | 904-244-3425
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY7432
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License Number State | FL
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