MEDICARE: HENRY G CHAVEZ CUFFARO 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	2084P0800X	Psychiatry Physician	R0206	TX
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2084P0800X	Psychiatry Physician	ME167005	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912348061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY G CHAVEZ CUFFARO M.D.

Provider Business Mailing Address
First Line	:	330 SEVEN SPRINGS WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5098
Country	:	US
Telephone Number	:	615-920-7782
Fax Number	:	615-920-8775

Provider Business Practice Location Address
First Line	:	3060 LOOPDALE LN
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7659
Country	:	US
Telephone Number	:	407-775-2121
Fax Number	:	888-272-4324

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

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	06/10/2024

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