MEDICARE: DR. JOSE LUIS 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	208D00000X	General Practice Physician	35-043909	OH

General Provider Information

NPI Number	:	1427202670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE LUIS CHAVEZ M.D.

Provider Business Mailing Address
First Line	:	3380 ERIE AVE
Second Line	:	SUITE 100
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1626
Country	:	US
Telephone Number	:	513-533-2835
Fax Number	:	513-533-2843

Provider Business Practice Location Address
First Line	:	3380 ERIE AVE
Second Line	:	SUITE 100
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1626
Country	:	US
Telephone Number	:	513-533-2835
Fax Number	:	513-533-2843

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

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	11/13/2008

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