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General NPI Number Information
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NPI Number | 1992844906
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Entity Type | Individual
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Provider Name | DUANE CHASE MD
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 1510 PLATEAU DR
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City | GALLUP
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State | NM
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Zip | 87301-5021
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Country | US
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Telephone | 505-722-3100
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Fax | 505-722-3100
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Provider Business Mailing Address
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Address Line | 1510 PLATEAU DR
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City | GALLUP
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State | NM
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Zip | 87301-5021
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Country | US
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Telephone | 505-722-3100
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Fax | 505-722-3100
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2004-0375
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD2007-0779
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License Number State | NM
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