MEDICARE: DR. LAUREN HOLLINGSWORTH CHAVEZ 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	174400000X	Specialist	98-29	NM

General Provider Information

NPI Number	:	1386753283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN HOLLINGSWORTH CHAVEZ M.D.

Provider Business Mailing Address
First Line	:	1120 JUAN TABO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-5703
Country	:	US
Telephone Number	:	505-888-3733
Fax Number	:	505-888-3734

Provider Business Practice Location Address
First Line	:	1120 JUAN TABO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-5703
Country	:	US
Telephone Number	:	505-888-3733
Fax Number	:	505-888-3734

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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