=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508864703
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANFORD MARTIN CHESLER DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2005
-----------------------------------------------------
Last Update Date | 01/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 N 124TH DR
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85392-6516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-521-8110
-----------------------------------------------------
Fax | 623-935-6911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2120 N 124TH DR
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85392-6516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-521-8110
-----------------------------------------------------
Fax | 623-935-6911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 00145
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------