MEDICARE: DR. DORIS MARILU CHAVEZ MD

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	207Q00000X	Family Medicine Physician	S7405	TX
2	207Q00000X	Family Medicine Physician	MD2011-0563	NM
3	207Q00000X	Family Medicine Physician	58349	AZ
4	207Q00000X	Family Medicine Physician	35.140675	OH
5	207Q00000X	Family Medicine Physician	812	FL
6	207Q00000X	Family Medicine Physician	279186-1	NY

General Provider Information

NPI Number	:	1316101124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DORIS MARILU CHAVEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 26666
Second Line	:	PHS PROVIDER ENROLLMENT
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-6666
Country	:	US
Telephone Number	:	505-923-6770
Fax Number	:

Provider Business Practice Location Address
First Line	:	1436 WILLIAMSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2507
Country	:	US
Telephone Number	:	646-759-5453
Fax Number	:	646-374-4940

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

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	10/21/2020

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