Basic Information
| Provider Information | |||||||||
| NPI: | 1255312013 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHESSOR | ||||||||
| FirstName: | ALFREDMY | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 JEFFERSON ST NORTH | ||||||||
| Address2: | |||||||||
| City: | WADENA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186313510 | ||||||||
| FaxNumber: | 2186317507 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 DEERWOOD AVE NW | ||||||||
| Address2: | |||||||||
| City: | WADENA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186311360 | ||||||||
| FaxNumber: | 2186317507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 22199 | SC | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.