=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891060646
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEROME ALLEN CHATOW M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2012
-----------------------------------------------------
Last Update Date | 03/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35935 ROYAL SAGE CT
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92211-2717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-772-1147
-----------------------------------------------------
Fax | 206-203-1274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35935 ROYAL SAGE CT
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92211-2717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-772-1147
-----------------------------------------------------
Fax | 206-203-1274
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | GFE9522
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------