MEDICARE: MICHAEL W. CHANCELLOR, M.D., PLLC

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	2085R0001X	Radiation Oncology Physician	E-5444	AR

General Provider Information

NPI Number	:	1902089964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL W. CHANCELLOR, M.D., PLLC

Provider Business Mailing Address
First Line	:	3425 S ATLANTIC AVE APT 906
Second Line	:
City	:	DAYTONA BEACH SHORES
State	:	FL
Zip	:	32118-6363
Country	:	US
Telephone Number	:	479-831-9545
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 S ATLANTIC AVE APT 906
Second Line	:
City	:	DAYTONA BEACH SHORES
State	:	FL
Zip	:	32118-6363
Country	:	US
Telephone Number	:	479-831-9545
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL W CHANCELLOR
Credential	:	M.D.
Telephone Number	:	479-831-9545

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	01/20/2010

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