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General NPI Number Information
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NPI Number | 1851356265
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Entity Type | Individual
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Provider Name | DAYCHA CHEANVECHAI MD
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3625 UNIVERSITY BLVD S EMERGENCY DEPARTMENT
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4207
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Country | US
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Telephone | 904-399-6156
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Fax |
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Provider Business Mailing Address
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Address Line | 9745 TOUCHTON RD UNIT 3107
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City | JACKSONVILLE
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State | FL
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Zip | 32246-4487
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Country | US
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Telephone | 904-399-6156
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME76415
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License Number State | FL
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