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1760477582

NPI Code Detail

MEDICARE: JAMES BRETT CHAFIN MD

MEDICARE: JAMES BRETT CHAFIN 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	207Y00000X	Otolaryngology Physician	18351	WV
2	207Y00000X	Otolaryngology Physician	33730	KY
3	207YP0228X	Pediatric Otolaryngology Physician	ME108101	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040010292	OTHER	WV	RR MEDICARE
2	040011865	OTHER	KY	RR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1760477582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES BRETT CHAFIN MD

Provider Business Mailing Address
First Line	:	PO BOX 191
Second Line	:	PROVIDER ENROLLMENT DEPARTMENT
City	:	ROCKLAND
State	:	DE
Zip	:	19732-0191
Country	:	US
Telephone Number	:	302-651-6212
Fax Number	:	302-651-4945

Provider Business Practice Location Address
First Line	:	807 CHILDRENS WAY
Second Line	:	NEMOURS CHILDRENS CLINIC, JACKSONVILLE
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8426
Country	:	US
Telephone Number	:	904-697-3694
Fax Number	:	904-697-3927

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	09/08/2011

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Directions to “ JAMES BRETT CHAFIN MD” Practice Location

Language	Start Address	Practice Location

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