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General NPI Number Information
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NPI Number | 1649427634
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Entity Type | Organization
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Legal Business Name | MARY ANN CHAVEZ DO PC
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 02/09/2010
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Provider Practice Location Address
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Address Line | 222 W BEECH ST
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City | SULLIVAN
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State | IN
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Zip | 47882-1462
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Country | US
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Telephone | 812-268-3901
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Fax | 812-268-0674
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Provider Business Mailing Address
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Address Line | 222 W BEECH ST
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City | SULLIVAN
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State | IN
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Zip | 47882-1462
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Country | US
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Telephone | 812-268-3901
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Fax | 812-268-0674
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MARY ANN CHAVEZ
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Credential | DO
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Telephone | 812-268-3901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02002313A
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License Number State | IN
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