MEDICARE: ROBERT M CHAPA SR. 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	2083X0100X	Occupational Medicine Physician	ME44645	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588780928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT M CHAPA SR. M.D.

Provider Business Mailing Address
First Line	:	5600 SPRING PARK RD
Second Line	:	SUITE 200
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5988
Country	:	US
Telephone Number	:	904-379-1203
Fax Number	:	904-379-9282

Provider Business Practice Location Address
First Line	:	5600 SPRING PARK RD
Second Line	:	SUITE 200
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5988
Country	:	US
Telephone Number	:	904-379-1203
Fax Number	:	904-379-9282

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/08/2012

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