MEDICARE: DR. JERALD DUANE CHAFFIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	R6A25	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E-4430	OTHER	AR	ARKANSAS LICENSE
2	R6A25	OTHER	MO	MISSOURI LICENSE

General Provider Information

NPI Number	:	1164465613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERALD DUANE CHAFFIN M.D.

Provider Business Mailing Address
First Line	:	125 STONERIDGE DR
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-3714
Country	:	US
Telephone Number	:	417-334-1682
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W US HIGHWAY 60
Second Line	:
City	:	MOUNTAIN VIEW
State	:	MO
Zip	:	65548-8542
Country	:	US
Telephone Number	:	417-934-7090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JERALD DUANE CHAFFIN M.D.” Practice Location

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